HomeMy WebLinkAboutBLD1988-00292 UILDING PERMIT APPLICATION
Jefferson County Building rtment•• County Courthouse •Port Townser,/ash.98368 • 385-9141
N E
I. LOCATION: geographic name S W SIDE OF �/ ROAD FEET
N E J ( O E'y r /1
S W FROM INTERSECTION OF / p ROAD AND r�n _._S�-�/� AD
other specific location or landmark: 0 �-.-1 (cv V v t
LEGAL !Mr: ( 5 P7e Lot Block / Subdivision,
i c7 ,(k)
c7---2 / 0 ()cj f ,), Tax Number Y4 Section Section Township Range
II.TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
ew building cingle Family ❑New County Resident
❑Addition ulti-Family Is this structure to serve the residential
❑Alteration number of units 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 ❑Mobile Home
❑Moving (relocation) ❑Other-Specify
❑YES ❑NO
❑Foundation only
USE
OWNERSHIP
❑Full-time Residence
❑Private (individual,corporation, ❑Second Home: Recreation Cabin,etc.
nonprofit institution,etc.)
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: / _''z ❑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.
C, 2
b. Plumbing
` c. Heating,air conditioning .�. UC '� ; l Ce l 1 a lD
"v d. Other (elevator,etc.) t-. O� C2
7�o1116)
S 7( Q
(�.7 • TOTAL COST OF IMPROVEMENT $ / - / C�
�,, / �IJ ( Co
` III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
El Masonry (wall bearing) •Number of Stories
❑Public or Private •Total square feet of floor area,
flood Frame ndividu (septic tank etc.) all floors,based on exterior
t9 �LI Structural steel dimensions
�.,,��ry
W ❑ TYPEF WATER SUPPLY Reinforced concrete •Total land area,sq.ft.
Public or private company
Cr ❑Other-Specify NUMBER OF OFF-STREET
❑individual (well,cistern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
El oil RESIDENTIAL BUILDINGS ONLY
CO (j Electricity Number of bedrooms
Loal TYPE OF MECHANICAL
O h eci Number of Full
fi, yv) bathrooms
f/l/ Partial
IV. IDENTIFICATION -
Name Mailing Address-Number,street,city nd State ZIP code Tel. No.
t. � )-44A--Q- S IO r i 3 -.s?//
Owner
.
C
Contractor State License No.
3.
Architect
The owner of this building and the u ersigned agree to conform to all applicable laws.
Signature applicant Address Applica ' n d e
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PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY I —')
0 V M G kf (0 S//0/�56
JEFFERSN COUNTY HEALTH DEPARTMENT
APPROVED BY: PERMIT FEE ISSUE DATE
7�/ ,rt„ RECEIPT NUMBER
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BUILDING OFFICIAL / S R c 3 7
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\ FEB 2 9'88
JEFF. COUNTY
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