HomeMy WebLinkAboutBLD1987-00467 Lt,L1)1,... t t_E,;,;I i `1 , LIC A I (UN
Jefferson County Built Department • County Courthouse • Port fliisend, Wash. 98368 • 385-1310
•
N E `
I. LOCATION: geographic name S W SIDE OF ROAD______ �
FEET
S W FROM INTERSECTION OF ROAD AND al I ROAD
' other specific location or landmark:
Q if 4 .
LEGAL DES IPTION: ) `'
Lot Block S bdivision -
ts'r Tax Number '4 Section Section Township Range
` •
'*.,- II. TYPE AND COST OF BUILDING -
.: TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY '
! SSiNew building ❑Single Family ❑New County Resident
Addition ❑Multi-Family Is this structure to serve the residential
number of units
C--.-` ❑Alteration or commercial needs of those employed
I ❑Hotel,Motel, Dormitory at either the US.Navy's Trident or
❑Repair,replacement number of units ?
. Indian Island Facilities.
❑Wrecking obile Home
❑Moving (relocation) ,Iri' J
►Tj Other� gecify /lJ ❑YES ❑NO
❑Foundation only i c
USE
OWNERSHIP
❑Full-time Residence
❑Private (individual,corporation,
nonprofit institution,etc.) -, ❑Second Home: Recreation Cabin,etc.
'' S CI Home: Future conversion to
CD Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: t 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 industr al plant.
a. Electrical If use of existing building is being changed,enter proposed use. CL 0,___\
-J .�
b. Plumbing 1 ,�x 4 ;1 , awV
c. Heating,air conditioning l '4,7111
Other (elevator,etc.) • I CLICQ_-- ` Q l ) U
• TOTAL COST OF IMPROVEMENT $
III.SELECTED CHARACTERISTICS OF BUILDING - JO (
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DI e -LI
DIMENSIONS
IlD Masonry (wall bearing) ❑Public or Private •Number of Stories
Vndividual
•Total square feet of floor area,
0 Wood Frame septic t„rt etc.) all floors,based on exterior
Structural steel dimensions
El Reinforced concrete TYPE OF WATER SUPPLY •Total land area,sq.ft.
❑Public or private company
Other—Spec' y NUMBER OF OFF-STREET
❑Individual (well,cistern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
n Mn Outdoors
El Oil RESIDENTIAL BUILDINGS ONLY
❑Electricity Number of bedrooms
❑Coal TYPE OF MECHANICAL
Number of Full
El Other—Specify bathrooms
Partial
IV. IDENTIFICATION- SW ��
N e Mailing Address—Number,street,city and State ZIP code Tel.No.
CCJaCc( 6 IP ieloce 5 ;r4--2,„ W a, ---7t3-F cr336s) - Res-7.
erAO vr, C(I ..\
il
, --rill-s
�„,, , 0
...• ,r �]�� State License No.
r •
he owner of this building and the undersigned agree to conform to all applicable laws.
ignature of applicant Address Application date
�:e ' 0 • 3�C r.e 13 J € -/7- s---7
PLANNING AREA % FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPR V D BY
JEF i- • C HEALTH DEPARTMENT -
• APPR : ` ERI TFEE ISSUE DATE RECEIPTNUMBER _
57 7-Di --;-° ' .2.-.D.o 7 3 LLS
BUR DING OFFICIAL
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