HomeMy WebLinkAboutBLD1988-00069 dli BUILDING PERMIT APPLICATION '
Jefferson County BuiidM�, Department• County Courthouse • Port Tow, ,d, Wash.98368 • 385-9141
N E
I. LOCATION: geographic name S W SIDE OF ROAD _ FEET
N E 81 I A �
S W FROM INTERSECTIJl
OF r ROAD AND PCL "' (.t CMS uY\-- � S ROAD
other specific location or landmark: � I�T�IC/lf�m�r iCl 0 / —�t G
LEGAL DESCRIQjION: `j V z s c
f` �(`,vQ" Lot Block Subdivisig i /' 1
/1
ggC .( 0 UCROS Tax Number '4 Section Section Township Range
II.TYPE AND COST OF BUILDING-
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
7:54.2v 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
❑Repair,replacement El Hotel,Motel,Dormitory at either the U.S.Navy's Trident or
number of units Indian Island Facilities?
❑Wrecking ❑Mobile Home
❑Moving (relocation)
❑Other-Specify ❑YES ❑NO
❑Foundation only
USE
OWNERSHIP
❑Full-time Residence
❑Private (individual,corporation,
nonprofit institution,etc.) f t ❑Second Home: Recreation Cabin,etc.
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP:S`� -' ❑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 (_D 43 -CD @3s � f -7oc0
c. Heating,air conditioningCaa ( O 9070
d. Other (elevator,etc.) 6 a ! -D-- e,`)E f € y(0 9
• TOTAL COST OF IMPROVEMENT $ __-
III.SELECTED CHARACTERISTICS OF BUILDING - i,(3 CI O S`
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE S DIMENSIONS
\ •Number of Stories
IDMasonry (wall bearing) ❑Public or Priva •Total square feet of floor area,
Wood Frame all floors,based on exterior •
❑St ctural steel dimensions
TYPE OF WATER SUPPLY
❑Reinforced concrete •Total land area,sq.ft.
❑Other-SpecifyPublic or private company
NUMBER OF OFF-STREET
❑Individual (well,cistern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY
electricity Number of bedrooms
❑Coal TYPE OF MECHANICAL
❑Other-Specify
Number of {Full
bathrooms
Partial 1/
IV. IDENTIFICATION-
Name Mailing Address- Number,street,city and State ZIP code Tel.No.
ter
tractor ! t?Lic set c2.1 4D 11�
3. �
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
ign of app' ant covvvveja Addr� Appl' n ati date
,9/
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY 0 Q,Vy vY
JE F �F_ ON COU H-A EPARTMENT
APf :t`R"1� I~ D
II® PERMIT FEE ISSUE tTE RECEIPT NUMBER
3 I CiS 3
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