HomeMy WebLinkAboutBLD1987-00433 >UiLDi “v l'Li,!,.i ( APPLICA i ION
Jefferson County Buildeepartrnent • County Courthouse • Port Tov d, Wash.98368 • 385-1310
N E
I. LOCATION: geographic name S W Si DE-OF ROAD FEET
NE
S W FROM INTERSECTION OF ROAD AND AD
- other specific location or land J 1 mark. ,r / 'l
LEGAL ESCRIPTION: 1 / ` q C�k, 4/ 1-��
Lot Block Sub ivA) / ,
6/6 cap! /70 Tax Number %Section Section Township /��`Raannge
II.TYPE AND COST OF(BUILDING -
T.YYPPE,(OF IMPROVEMENT BUILDING TYPE MOBILITY •
tLv New building Angle Family ❑New County Resident
/❑Addition ��F❑��`Multi-Family Is this structure to serve the residential
❑Alteration number of units or commercial needs of those employed
❑Hotel,Motel, Dormitory at either the US.Navy's Trident or
❑Repair,replacement number of units
Indian Island Facilities?
❑Wrecking obile Home
❑Moving(relocation) ❑Other—Specify ❑YES LINO
❑Foundation only
USE
OWNERSHIP
❑Full-time Residence
❑Private (individual,corporation, / ❑Second Home: Recreation Cabin,etc.
nonprofit institution,etc./ 9 1
❑Public (Federal,State or local ov't.) UBC OCCUPANCY GROUP: ElSecond Home: Future conversion to
permanent residence
� COST (Omit cents) Nonresidentia — Describe in detail proposed use of buildings,e.g.,food
N.\ 1 • Cost of improvement $ processing plant,machine shop,laundry building at hospital,elementary
To be installed but not included school,secondary school,college,parochial school,parking garage for
�% in the above cost department store,rental office building,office building at industrial plant.
, a. Electrical If userof existing building is being changed,enter proposed use.
b. Plumbing L qy `,,,
,9
�\
, s. , c. Heating,air conditioning =-. Year / '
d. Other (elevator,etc) ,( t01/41 r
( • TOTAL COST OF IMPROVEMENT $
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DIS DIMENSIONS
❑Masonry (wall bearing) •Number of Stories
❑Public or Private
•Total square feet of floor area,
❑Wood Frame )Individu((se is tank,etc.) all floors,based on exterior
ID Structural steel \\ dimensions
Reinforced concrete TYPE OF SVp1�� •Total land area,sq.ft. —
❑ Public or ivate company
Other—Spec' NUMBER OF OFF-STREET
►flI/m/ 0 h ID Individual (well,cistern) PARKING SPACES -
F U�{'' Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors —
❑,/Oil RESIDENTIAL BUILDINGS ONLY
�1 Electricity Number of bedrooms
✓❑Coal TYPE OF MECHANICAL
Number of Full
❑Other—Specify bathrooms
Partial
IV. IDENTIFICATION- •
-
Name }r Mailing Address Number,,st'r�t,city and State ZIP code Tel.No.
1.
Owner l li �I • ail( Oc (
2. 1 ` �1 l_
Contractor State License No.
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
1 Signature of applicant Ad ress Applicatlo ate
PLANNING AREA N FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED B - /Q c It'd 9/i/
JEFFERSON COUNTY HEALTH DEPARTMENT •
APPROVE . 77
..
�jPERMIITT FEE ISSUE DATE RECEIPT NUMBER
/ S v�/( LJ 5
,,,,
ci _ a --cv
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