HomeMy WebLinkAboutBLD1988-00278 BUILDING PERMIT APPLICATION
Jefferson County Buila' partment• County Courthouse • Port Towr1 ', Wash.98368 • 385-9141
• N E _
I. LOCATION: geographic name S W SIDE OF ROAD FEET
NE
S W FROM INTERSECTION OF ROAD AND D O AD
other specific location or landmark: -----
(�4.471LESCRIPTION:yD `QcW f 1
O ILot Block Subd isron 0 0 ®r, Tax Number Ya SectionOP< (k)
` Sec n Township Range
II. TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
(
LPEyew building Single Family
\ � am ❑Neva County Resident
❑Addition ❑ ulti-Family
Is this structure to serve the residential
Ell Alteration number of units or commercial needs of those employed
❑Hotel,Motel, Dormitory at either the U.S.Nav s Trident or
❑Repair,replacement number of units y
Indian Island Facilities?
❑Wrecking ❑Mobile Home
❑Moving (relocation)
❑Other—Specify El YES ENO
❑Foundation only
USE
OWNERSHIP
El 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
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 - yfip 0
c. Heating,air conditioning
r i /fir f - aw.." i ,: A el 0♦ "! ,2___.
d. Other (elevator,etc.) ,
• TOTAL COST OF IMPROVEMENT $ c.-- /
III.SELECTED CHARACTERISTICS OF BUILDING - G �l
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE LSIS DIMENSIONS !
❑Masonry (wall bearing) C •Number of Stories tF
Li Public or Private i.
Wood Frame r —7 •Total square feet of floor area,
� Individ I (septic tan etc.) all floors,based on exterior
❑Structural steel dimensions
❑Reinforced concrete TYPE OF WATER SUPPLY •
Total land area,sq.ft.
❑Other—Specify Public 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
ItiElectricity Number of bedrooms
El Coal TYPE OF MECHANICAL
{rz
they— eci y Number of
Full
Y % 1 bathrooms
Partial
IV. IDENTIFICATION -
Name Mailing Address—Number,street,city an` t to ZIP code Tel.No.
1. `
Owner
ga-ki '
4
S-"s//
V���or d e(� State License No. p s36/ /i --3"
3.
Architect
0
The owner of this building and the undersigned agree to conf./....75a r,‘i
orm to all applicable laws. .
ignatu off aapplicant / Addr s Applica on `a e
ce t)
7
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY __ i cl' q / 0
(-62//' e-11(
JEFFERRO HEALTH DEPARTMENT
APPROVED BY:f 1 \ PERMIT FEE ISSUE DATE RECEIPT NUMBER
(.0//V/3R 3cq(e-?S
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