HomeMy WebLinkAboutBLD1987-00451 BUILDING PERMIT APPLICA1 ION
R E C E 1 C on County Buildinpartment• County Courthouse • Port Towns, Wash.98368 • 385-1310
JEFFERSON erU TY
N E
It, 1.43CA'1 O1WIH N E raphic name SW SIDE OF ROAD FEET
F CANNING DEPARTMiIVI,y�,FROM INTERSECTION OF ROAD AND (k) ) 1I1) -) ROAD
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By »•••••»•••••otherapeeitia.location,or landmark: �� L` '''� Sr (% U ti l CPA.)P
LEGAL DESCRIPTION: / Co , e
Pq (�Q�
(j - Block Subdi 1 n
o Tax Number '%Section Section Township Range
II.TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY •
"New building ❑Single Family ❑New County Resident
❑Addition ❑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?
❑WreckingMobile Home
❑Moving (relocation) ❑Other—Specify ❑VES ❑NO •
❑Foundation only
USE
OWNERSHIP ❑Full-time Residence
❑Private (individual,corporation, ❑Second Home: Recreation Cabin,etc.
nonprofit institution,etc.)
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: --3_ ❑Second Home: Future conversion to
permanent residence
COST (Omit cents) Nonresidential—Describe in detail proposed use of buildings,e.g.,food
• 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 use of existing building is being changed,enter proposed use.
b. Plumbing 17& lb) ' 50 /,
y
c. Heating,air conditioning
d. Other (elevator,etc.)
• TOTAL COST OF IMPROVEMENT $
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
•Number of Stories
❑Masonry (wall bearing) ❑Public or Private •Total square feet of floor area,
❑Wood Frame Individ (septic t�k, ta) all floors,based on exterior
dimensions
❑Structural steel
t r�a ❑Reinforced concrete TYPE OF WATER SUPPLY •Total land area,sq.ft.
v ✓
' p,- ❑Public or private company
Other—Speck ^�, d Yim✓/J NUMBER OF OFF-STREET
I-e _ ak LI. ' ,r'e �,J Individual cistern) PARKING SPACES
\ Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
Outdoors
❑Gas
' ❑Oil RESIDENTIAL BUILDINGS ONLY `�
C° "Electricity Number of bedrooms -.>L—.
TYPE OF MECHANICAL i
❑Coal Number of Full I
❑Other—Specify bathrooms I
Partial
IV. IDENTIFICATION- -
•
Name Mailing Address—Number,street,city and State ZIP code Tel.No.
1. UP.15 r'ra V ,_fir o i / Pam. 0 , ii 3� (,) 13 3�
Owner , Pv 1S.d 6 ) /C1 7 3
2.
Contractor State License No. 206 737--2J )'
• 3.
Architect
The owner of this building `d he u rsigned agree to conform to all applicable laws.
Signate'of a cant J. Address
Application date
PLANNING AREA FIRE DISTRICT S HOOL DISTRICT WATER DISTRICT
APPROVED BY \c \p� �` � r-0,��z 2� 5'�l
JEFFER COUNTY HEALTH DEPARTMENT •
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APPROVE PERMIT FEE ISSUE DATE RECEIPT NUMBER
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BUILDING OFFICIAe J
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