HomeMy WebLinkAboutBLD1987-00460 Jefferson County Bulk-1 'P,rtment• County C�_ ,.hog �4: • Port Tow; , Wash.98363' • 385-1310
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I. LOCATION: geographic name S W SIDE OF ROAD FELT
NE
S W FROM INTERSECTION OF 50 ROAD AND ^' �y� �n S ROAD
other specific location or landmark: I I O(S Gar ai r \'r'r go a_ )
LEGAL DESCRIPTION:
�j Lot Block �� 53 Subdivision •
(`���-- LO
/� 00� I v ��C Number Loss Y.Section Sec �ownship 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
RECEIVED number of units or commercial needs of those employed
❑Alteration JEFFERSON COUNTY ❑Hotel,Motel, Dormitory at either the US.Navy's Trident or
❑Repair,replacement number of units
Indian Island Facilities?
❑Wrecking
Ali )j1 ❑Mobile Home
❑Moving(relocation) ❑Other—Specify ❑VES ❑NO
❑Foundation oki,ANNING DEPARTMENT
• USE
OWNERSHIP pull-time Residence
•
❑Private (individual,corporation,
nonprofit institution,etc.) // econd Home: Recreation Cabin,etc.
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: !� ❑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 uus/e of kkexistingg building is being changed,enter proposed use.
b. Plumbing /�4O Y�'kdI r\ !`r 35 �412 OOO
i c. Heating,air conditioning r x 40 t b 3e..v w At al (0VO
V 2..O I
1 Q/'
d. Other (elevator,etc) t /( O
• TOTAL COST OF IMPROVEMENT $ LJ
5,2 11L O
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
❑Masonry (wall bearing) •Number of Stories
❑Public or Private
•Total square feet of floor area,
\(Wood Frame ndividual (septic tank,etc.) all floors,based on exterior 1,2 0 O
❑Structural steel dimensions
❑Reinforced concrete TYPE OF WATER SUPPLY •Total land area,sq.ft. 7.Sderes
•
Public or private company
❑Other—Specify NUMBER OF OFF-STREET
❑Individual (well,cistern) PARKING SPACES
Enclosed ®®
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACEyzi Gc,T
Gas Outdoors �F
❑Oil• N r &LUv�UIJh(CJ1 RESIDENTIAL BUILDINGS ONLY
Electricit Number of bedrooms
❑Coal TYPE OF MECHANICAL
Number of Fufl
❑Other Specify bathrooms
��5. -CA)'€ Partial a
IV. IDENTIFICATION- • •
Name Mailing Address—Number,street,city and State ZIP code Tel.No.
t. Frei__ Sm.t LX L Cold Ga v6I i vu.r ?cad , _
Owner S I,(,i VYl 9 2- 713
2. (A.ber n h'S )-U M6 eW 23K1
7S
Contractor � 5 �Lice N . l ,► DI geV 7_ z- ) D 3. L :�� .
Architect ')
The owner of this building and the undersigned agree to conform to all applicable laws. ����j�/
Sign of applicant Address Application d to
0 Pi ig.(r) Pii
PLANNING AREA % FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVD BY kq ir_a,j> '17//8
JEFFERSON COUNTY HEALTH DEPARTMENT -
APPROVED BY: PERMIT FEE ISSUE DATE RECEIPT NUMBER
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