HomeMy WebLinkAboutBLD1987-00464 _ lir— - — __
S W SIDE OF ROAD — �E_L VJ
I. LOCATION: pcopraphic name r n �y
N E ���I l�I� 7�J� ROAD
S W FROM INTERSECTION OF ROAD AND
other specibc location or landmark: ICIN
( L 7Q sL-.; ( 1 s 10300 , v.,_,)1 00 7i(
LEGAL ESCRIPTION: Block Subdivisi'Ctt !
Loth— a UJ
ao ((007) � Section Township Range
lI l_lL1 Tax Number Y.Section
II.TYPE AND COST OF BUILDING-
TYPE OF IMPROVEMENT BUILDING TYPE
c N PUBLIC WORKS APPROVALew building ❑Single Family ,
Addition ❑Multi-Family Road Access Permit No.
number of units
❑Alteration 0 Hotel,Motel, Dormitory Utility Permit No.
Repair,replacement _ _ number of units •
Wrecking •r MI obile Home Emergency Services No.
0 Moving(relocation) IN c her—Specify Street Width A•
❑Foundation only
B:
. Additional Permits Required:
OWNERSHIP
0 Private(individual,corporation,
nonprofit institution,etc.) �-J
❑Public(Federal,State or local gov't.) UBC OCCUPANCY GROUP:
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,perking garage for
in the above cost department store,rental office building,office building at industrial plant.
If use of existing building is being changed,enter proposeduse.
a. Electrical
b. Plumbing /�4 6
G /
Heating,air conditioning ( 9
d. Other(elevator,etc.)
• TOTAL COST OF IMPROVEMENTS
III.SELECTED CHARACTERISTICS OF BUILDING - ►
DIMENSIONS h • �PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE OIS •Number of Stories
Masonry(wall bearing) ❑Public or Private ` •Total square feet of floor area,
O Wood Frame ,'JIndividua�(septic tk, tc.) all floors,based on exterior {dimensions-
0Structural steel• TYPE OF WATER SUPPLY •Total land area,sq.ft-❑Reinforced concrete0 Public a company
ether—Sped • NUMBER OF OFF-STREET
" jndividual 0cstern) PARKING SPACES����.�� Enclosed
L RINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE •
Outdoors0 Gas❑Oil RESIDENTIAL BUILDINGS ONLY
Number of bedrooms ElectriatyTYPE OF MECHANICAL❑Coal FullNumber of �,
❑Other—Specify bathroomsParty p.
IV.IDENTIFICATION i`
Mailing Address—Number,street,city and S e ZIP code Tel.No.
/ /_
t. I IUCTAll VelVe a 0 _ ,
2 State Ltoense No. 1 I
Contractor I
3. -
Architect 1 _
The owner of this building and the unde igned agree to conform to all applicable laws.St
f
gnaturs9f toot /ssss Applraton date
'%
_ am •- >! /P//( 2 iq -7/-rLnA),_ 6'_ _ .
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT 1-
APP(O JED B APPROVED 3Y APPROVED BY
C � 4.—L' " / nt= C PT. PLANNING DEs'T. [.i.;
HEALTH DEP'f SHOP.EL 1 NE E
AJEF PRO ,E. PE RMIT FEE ISSUE DATE RECEIPT NUMBER
c2,_____/ (...." co-0 .
BUILDING OFFICIAL l L 0 /
JEFFERSON TITLE COMPANY
936 Washmaton St.• P.O.Box 256.Port Townsend.WA•(206)385-2000
The map is for your information. It is not intended to
express your exact boundaries nor is it intended to depict
the actual location of existing easements, streets, roads
and highways. The Company assumes NO LIABILITY for
any LOSS occurring by reason of reliance thereon.
JEFFERSON TITLE COMPANY
NANCY RODGERS
997 OLD TARB00 LAKE ROAD
QUILCENE, WA 98376
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