HomeMy WebLinkAboutBLD1988-00268 BUILDING PERMIT APPLICATION
Jefferson County Buildiepartment• County Courthouse • Port Tow,, Wash.98368 •• 385-9141
N E '
I. LOCATION: geographic name S W SIDE OF 'SAD FEET
N E i 9/ 44, Q ROAD
S W FROM INTERSECTION OF ROA/D�AND � /
other specific location or landmark: VV 1 - � � 1 f
^fLEGAL D13SIPTION: (° � IL,
Pi4Q- +t�.Y.-- Lot Block Subdivi • n 1
( l( � V Tax Number '/.Section Section 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
number of units
❑Alteration or commercial needs of those employed
❑Hotel,Motel, Dormitory at either the U.S.Navy's Trident or
❑Repair,replacement number of units
Indian Island Facilities?
❑Wrecking Lobile Home
❑Moving (relocation)
❑ her—Specify ❑YES ❑NO
❑Foundation only
OWNERSHIP USE
❑Full-time Residence
❑Private (individual,corporation,
nonprofit institution,etc.) ❑Second Home: Recreation Cabin,etc.
❑Public (Federal,State or local gov't,) UBC OCCUPANCY GROUP: ❑Second Home: Future conversion to
p
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
Nin 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.
*.e,Q b. Plumbing I(� �`�
c. Heating,air conditioning / �/
d. Other (elevator,etc.) L' a' ce4Aa
• TOTAL COST OF IMPROVEMENT $
III.SELECTED CHARACTERISTICS OF BUILDING -
" - PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DJ SIONS
❑Masonry (wall bearing) •Number of Stories
❑ •Public or Private
•Total square feet of floor area,
❑Wood Frame Individua eptic tank, tc.) all floors,based on exterior
❑Structural steel dimensions
t. ❑ einforced concrete TYPE OF WATER SUPPLY •Total land area,sq.ft.
❑Public o company
t er—Specify } !^ NUMBER OF OFF-STREET
��,,.K�tr p _/ � Llndivi al (well, istern) PARKING SPACES
NNYYY 111 l/ fl V� �C ��� Enclosed
PRINCIPAL TYPE OF EATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY
Electricity Number of bedrooms
❑Coal TYPE OF MECHANICAL
❑Other—Specify
Number of Full
bathrooms ,,....i31..--.
Peteial
IV. IDENTIFICATION -
Name Mailing Address—Number,street,city and State ZIP code Tel.No.
t. D (4--�T6EL 4eg() r4ubur 4)111) .s4s ` a 9s
Owner o� ,/� AD J r 677/
%..-)2. ,]�f}
Contractor State License No.
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Si lure o a nt Address • A li lion to
PLANNING AREA IRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
-APPROVED BY
Jar fr
• I,. HEALTH DEPARTMENT
APPROVED Y: I P•F`RMI. E IS UE DATE RECEIPT NUMBER
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APPROVED
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