HomeMy WebLinkAboutBLD1988-00296 BUDING PERMIT APPLICATIO '
Jefferson County Bui�Department• County Courthouse • Port Tosnd, Wash.98368 • 385-9141
N E
I. LOCATION: geographic name S W SIDE OF ROAD FEET
N E
S W FROM INTERSECTION OF ROAD AND CiTh IITVI LOG)A Cr, Dr. ROAD
other specific location or landmark: 1 \
I-
LEGAL DESCRIPTION: O 4 (O �1 ICYY-S- )cr Creek f O •Z
Lot Block Subdivision
LI 2 a'�) o2Q 11)
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`I 93 7t�(XC. 4 OO7 Tax Number %Section Section Township Range
II.TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
t
2 New building Single Family Li New County Resident
�❑Addition ❑Multi-Family Is this structure to serve the residential
number of units
El Alteration or commercial needs of those employed
❑Repair,replacement ❑Hotel,Motel, Dormitory at either the U.S.NavyRTEdei t E I V E ID
number of units Indian Island Facilities?
❑Wrecking El Mobile Home
❑Moving (relocation) FEB 2 5 1988
El Other—Specify CI YES ONO
El Foundation only JEFFERSON COUNTY
PLANNING&SLOG OFPT
USE
OWNERSHIP
❑Full-time Residence
El Private (individual,corporation,
nonprofit institution,etc.) �J� CI Second Home: Recreation Cabin,etc.
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: /v5 ❑Second Home: Future conversion to
1 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 Main .. i a�3 D p 4,35 J5 - 4 1-1 q 05
c. Heating,air conditioning r--.) a r : "-i o O Lii (, i _ 3) o2 OO
d. Other (elevator,etc.) e) �e (GAO s 6 1 `�'� . l�Q_
• TOTAL COST OF IMPROVEMENT $ �G7 53/ (`) ki5
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
Masonry (wall bearing) •Number of Stories
`❑4 9 El Public or Private •Total square feet of floor area,
Wood Frame
Individu t(septic tank tc.) all floors,based on exterior -
Cr ❑Structural steel dimensions
- ❑Reinforced concrete TYPE OF WATER SUPPLY
c •Total land area,sq.ft.
\( El Other—Specify El Public or private company
❑ NUMBER OF OFF-STREET Individual (well,cistern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
CI Gas Outdoors
SVO DOH RESIDENTIAL BUILDINGS ONLY
c 'lectricity Number of bedrooms
❑Coal TYPE OF MECHANICAL
gOther—Specify Number of Full t
�^1•tc Je bathrooms
tA..)0 Ca Partial
IV. IDENTIFICATION- •
Name Mailing Address— Number,street,city and State ZIP code Tel.No.
1 kt,; C'ntf-no Coo.c PO e)Ok I Z FS ) H 38339 --33 Z?
OWner
2. a(liA e,
Contractor State License'No.
3.
Architect
e wner of this building Wthe undersigned agree to conform to all applicable laws.
i natOre of a icant Address
Application date
- 4,..---' Oc7Z/OZ11 /8 6
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
AP2ROVED B,X,
AF�Q6� U® HEALTH DEPARTMENT
FEE ISS E DAT
RECEIPT NUMBER
F 198 15 , OC
3 . SO r N?7(e
BU I L Darrtj ofoity OO 67' 'W 3
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