HomeMy WebLinkAboutBLD1988-00274 BUILDING PERMIT APPLICATION
Jefferson County Buildinepartment• County Courthouse •Port Town Wash.98368 • 385-9141
N E
I. LOCATION: geographic name S W SIDt OF ROAD FEET
N E
S W FROM INTERSECTION OF ROAD AND aLQC.,J 6ECIC e °t• ROAD
other specific location or landmark: r
-, LEGAL DESCRIPTION: 0 + 14' k -P-E, ('.)c otk Be ch
''= - ParCP.I tI 6., 2Lot si)iBlock241 Subdivision
'' ( ( Tax Number %Section Section Township 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
❑,�Iteration number of units or commercial needs of those employed
Repair,replacement ❑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
ke ptoc t---nr5
..,7"` oncob(n USE
l OWNERSHIP Y
/
❑Private (individual,corporation, tlf r P
Li I Sid-' tnio' ° S c ❑Full-time Residence
nonprofit institution,etc.) ElSecond Home: Recreation Cabin,etc.
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: P--'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 building,office building at industrial plant.
a. Electrical If use of existing building is being changed,enter proposed use.
b. Plumbing
c. Heating,air conditioning
d. Other (elevator,etc.)
•
• TOTAL COST OF IMPROVEMENT $ (a r)
1
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
Masonry (wall bearing) •Number of Stories
❑ 9 ❑Public or Private •Total square feet of floor area,
12frood Frame `Individual septic tank, tc.) all floors,based on exterior
❑Structural steel / dimensions
TYPE OF WATER SUPPLY
LI Reinforced concrete � ✓ •Total land area,sq.ft.
�
Intl 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
: Electricity Life- Number of bedrooms
// I~I TYPE OF MECHANICAL
❑Coal �`���„3
Full
Number of
❑Other—Specify WJ,,oa 7to`rc bathrooms
Partial
IV. IDENTIFICATION -
Name Mailing Address—Number,street,city and State ZIP code Tel. No.
,. Rf-aY 6rphP_ 1 14 5 I? - , �enfi gb031 &5ti—
Owner
35109
2. c5e -e ���q�
3.
Contractor State License No.
!l11111���
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
NL/Signature ppli j'-1 (---
Address
Application dat
0510 88
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY
JEFFER N•� UNTY HEALTH DEPARTMENT.
APPROV DAB PERMIT FEE ISSUE DATE RECEIPT NUMBER
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