HomeMy WebLinkAboutBLD1988-00304 BUILDING PERMIT APPLICATION
Jefferson County Buildirepartrnent• County Courthouse •Port Townilk, Wash.98368 • 385-9141
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I. LOCATION: geographic name S W SIDE C•F- + ROAD FEET
N E aj,S W �p FROM INTERSECTION OF ROAD AND L..g atif- ROAD
iother specific location or landmark:
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Fo
LEGAL DESCRIPTION: /Cs
o S u Lot Block (�
on
1 ,. / ck
umber /o Section Section Township i ange -�
II. TYPE AND COST B axUILDING -
0,0 TYPE OF IMPROVEMENT
BUILDING TYPE MOBILITY
ANew building ❑Single Family ❑New County Resident
❑Addition ❑Multi-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. Nav
--,,.j ElRepair,replacement nu tuber of units__ y's Trident or
El Wrecking Indian island Facilities?
Mobile Home
El Moving (relocation) ���/// ��� /
❑Other-Specify ❑YES LBNp
❑Foundation only // �1
USE ,
OWNERSHIP Jf
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 p $ 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 `U ; '/ /r% '
\,,,;� C. Heating,air conditioning "�/ ) —/`y S'/.97 �` J
d. Other (elevator,etc.) Yna,/ n �/ //7 ,�e.; r
f ..11 t�X /� "� 1
• TOTAL COST OF IMPROVEMENT $
C.e,. { III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE'Ud5 1
DIMENSIONS /
9 El Masonry (wall bearing) ❑Public or Private.
•Number Stories (
r •Total square feet of floor area,
LI Wood Frame Individual (septic tank etc.) all floors,based on exterior
El Structural steel dimensions
Reinforced concrete TYPE OF WATER SUPPLY •
❑ Total land area,sq.ft. •
Other-Speci ❑Public or private company
G NUMBER OF OFF-STREET
\C1 rIVI . 1Individual (well,cistern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPL4 E
❑Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY
Electricity Number of bedrooms
❑Coal TYPE OF MECHANICAL
{
❑Other-Specify Number of Full
bathrooms
Partial
IV. IDENTIFICATION -
Name Mailing Address-Number,street,city and State ZIP code Tel. No.
t. Ic)/ � IS �/ Q'(; -
Owner 1 C
2.
Co.4Feet•o---. Stao•d-iconac PJ...
3.
Architect
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The owner of this building and the undersigned agree to conform to all applicable laws.
Signature of applicant Addre s Application date
XilQd-r/4 / "/771-(-'------- 'N... X.1/14//fri''''
PLANNING AREA FIRE DISTRICT _SCHOOL DISTRICT WATER DISTRICT
APPROVED BY ��/�
�/c' I`Yc'(' \ \l_ck^ �Lll^i C_C.GI llf..,r.- CO f��� 6i..+ i6<c+� f�...��
JEFFIA 1� CITY HEALTH DEPARTMENT t-a� '\ tLP 6)11 \,SP _TI, C .z-1 P
APPROVED BY: (� �/e PERMIT FEE I UE DATE Ag .1, RECEIPT NUMBER
JUN �75cOC�
BUILD1/4Ig UV NrY ` V 1d1717
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APPROVED
J U N 2 8 "a; — L �Q- igswiv
JEFFERSON COUNTY
PLANNING&B1DG DEFT
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