HomeMy WebLinkAboutBLD1988-00295 BUILDING PERMIT APPLICATION
Jefferson County 8L-lg Department• County Courthouse • Port end, Wash.98368 • 385-9141
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I. LOCATION: geographic name S W SIDE OF ROAD FEET
S W FROM INTERSECTION OF ROAD AN l ' )J ' ROAD
I1A/VYI
other specific location or landmark: r j�'�
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LEGAL DESK P I N: 2
p4)5) y 1 I Lot Sub- iv' io
t-415 700097 097 Tax Number /,Section ection ownship Range
II.TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
w building .I(I Single 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: ❑Second Home: Future conversion to
permanent resiI
COST (Omit cents) Nonresidential— Describe in detail proposed use of buildings,e
• Cost of improvement $ processing plant,machine shop,laundry building at hospital,el
To be installed but not included school,secondary school,college,parochial school,parking gar
in the above cost department store,rental office building,office building at indu
a. Electrical If use of existing building is being changed,enter proposed use
b. Plumbing /(0 t� 35 c. Heating,air conditioning "?�'"j t —•� C"/0('j d. Other (elevator,etc.)• TOTALCOSTOF IMPROVEMENT $
f
Q III.SELECTED CHARACTERISTICS OF BUILDING - r'C�' ., 1
0 PRINCIPAL TYPE OF FRAME TYPE OF SEWAG 4Y \p;z -- DIMENSIONS
Masonry (wall bearing) = •Number of Stories
0 ��\���\//////``` ❑Public or Pri •Total square feet of floor area,
p�Wood Frame \Individua (septic tank,etc.) all floors,based on exterio •
r
rl ❑Structural steel f ,� dimensions
iC" TYPE TER SUPPLY
El Reinforced concrete ., •Total land area,sq.ft.
Pub' r 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 '.��
VElectricity Number of bedrooms
Coal TYPE OF MECHANICAL
Other—
/ 1" Number of Full .
pe ✓�
bathrooms
Partial
IV. IDENTIFICATION- •
Name Mailing Address— Number,street,city and State ZIP code Tel.No.
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7
Owner (1Uy1
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2. -9_..? 9
Contractor State License,No.
1
3.
Architect
he ow er of t is b ildi a t undersigned agree to conform to all applicable laws.
nature;of a lira Ad ss
Applica ion date
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY f
" p p 0 4,, .17,I3�
JEFF NTY HE TH DEPARTMENT
Rp D PEJ, IT I SUE DATE
L 4��/C� RECEIPT NUMBER
PIANNINs&8I,0LI NTy i 1 (SCO�
BUILDINL;(9RCIAL 1 t/ _
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JEFFERSON COUNTY
PLANNING&BLDG DEFT
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