HomeMy WebLinkAboutBLD1987-00465 Jefferson County Buildingall3rtrnent• County Courthe • Port Town<i Wash. 98368 • 385-1310
N E
I. LOCATION: geographic name S W SIDE OF ROAD/ FEET
N E 6/3? o(�//e
S W FROM INTERSECTION OF ROAD AND ROAD
Other specific location or landma
LEGAL�p�EsCR�IPTION: L—
,�
la r / Lot Block Subdivision
7 I a, DO y ax Number Y.Section Section Township flange
II. TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY .
❑New building Single Family ❑New County Resident
ORCAddition El Multi-Family Is this structure to serve the residential
number of units❑Alteration or commercial needs of those employed
El Hotel,Motel, Dormitory at either the U.S.Navy's Trident or
❑Repair,replacement number of units Indian Island Facilities?
❑Wrecking ❑Mobile Home
❑Moving (relocation) L]Other—Specify ❑YES ❑NO
❑Foundation only / r�
C c�CP 'IS USE
OWNERSHIP ❑Full-time Residence
❑Private (individual,corporation, ❑Second Home: Recreation Cabin,etc.
nonprofit institution,etc.)ElPublic (Federal,State or local goVt.) UBC OCCUPANCY GROUP: 71,3 ❑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 bui(5jg,office building at,industrial plant.
a. Electrical If use of existing buildg is1:`�� hanged,enter proposed use.
b. Plumbing S • LO + 0
- --
c. Heating,air conditioning _- "'� 3
d. Other (elevator,etc.) /�/. �/ c//�
• TOTAL COST OF IMPROVEMENT $ C�p,/',J GG' /` ( f(2 ft' /yy0
III.SELECTED CHARACTERISTICS OF BUILDING - Fl\i. 1 -7��7 cV
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE Dt�$6 DIMENSIONS e if•Number of Stories /
O Masonry (wall bearing) ❑Public or Private •Total square feet of floor area, it
Wood Frame Individu septic tank,a c.) all floors,based on exterior
/ } dimensions
0 S ructural steel
TYPE OF WATER SUPPLY❑Reinforced concrete • J
•Total land area,sq.ft. 2
❑Public or private company
❑Other—Specify NUMBER OF OFF-STREET
❑Individual (well,cistern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY -} (
CIElectricity Number of bedrooms eXl S 1 ]0
❑Coal TYPE OF MECHANICAL ^�,
Number of Full 3 oxlls�lim
C' r ther Specify bathrooms Partial
IV. IDENTIFICA—ION- .
•
Name Mailing Address— Number,street,city and Stat ZIP code Tel.No.
1. K-( -K 31 0leJe Pe .Y.b K-�� ?0 � 7-- •
Owner �ht 0 tv, \ T r�l f 274
2. LX a-L- CO--t C� 1-1Y)
Contractor State License No.
c1(33
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
ignature pplicant tddr ss Appli lion d to
� /19-b( � V Q3/ G-7
PLANNING AREA \ C�FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
A 1 f J/EA�Y /I� /15-79
JEFFERSON Hl TH DEPARTMENT
APPROVED BY: PERMIT FEE ISSUE DATE RECEIPT NUMBER
,,q0„
7/
5-7p .
\ 30 ?(:72.N....,
BUILDING OFFICIAL £) `
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