HomeMy WebLinkAboutBLD1988-00306 BUILDING PERMIT APPLICATION
Jefferson County 8uil( Department• County Courthouse •Port Toed, Wash.98368 • 385-9141
N E
I. LOCATION: geographic name S W SIDE OF R D FEET
NE
S W FROM INTERSECTION
OF ROAD AND
jg.�� D
other specific location or landmark: 1 �Jy(.'o0_ �.+ �Q f/G ti
1- AL DESCRIPTION:
�� Lot Block Sub i ,7 1
700090, Tax Number 'A Section Se ion ownship Range
II. TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
New 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
LI Repair,replacement ❑Hotel,Motel, Dormitory at either the U.S.Navy's Trident or
number of units Indian Island Facilities?
❑Wrecking
❑Mobile Home
❑Moving (relocation)
( Other—Specify ❑YES ❑NO
❑Foundation only
Ar .
I. Sri k �jiT,iMlf r
_ir i. .•„-- E., USE
OWNERSHIP �, /
p ,Si9 4' ❑Full-time Residence
❑Private (individual,corporation,
nonprofit institution,etc.) El Second Home: Recreation Cabin,etc.
El 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 build g is being changed,enter proposed u e.
b. Plumbing y (.4°."?( -1#g� „_ 3 7 .
c. Heating,air conditioning
N? d. Other (elevator,etc.)
• TOTAL COST OF IMPROVEMENT $
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAp
'4 t OD IMENSIONS f
❑ asonry (wall bearing) 1 i •Number of Stories
❑Public or Private c ,
"" •Total square feet of floor area,
'"' Wood Frame Individu aseptic tank,'etc.) all floors,based on exterior
-) ❑ tructural steel __ dimensions
❑Reinforced concrete TYPE OF WATER SUPPLY •
Total land area,sq.ft.
❑Other—Specify ublic or private company
NUMBER OF OFF-STREET
,,l� ❑Individual (well,cistern) PARKING SPACES
- '..-* Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas /'may Outdoors
El oil // RESIDENTIAL BUILDINGS ONLY
❑Electricity Number of bedrooms
❑Co TYPE OF MECHANICAL
Number of Full ;C --
,,iQOther—Specify
.... bathrooms
Partial i e45:ko
ok
IV. IDENTIFICATION - �FJ17
Name Mailing Address—Number,street,city and State ZIP code Tel.No.
aq_
Owner .---i4467-
t-- •
2. C
Contractor State License No.
3.
Architect
The owner of t. bA
a undersigned agree to conform to all applicable laws.Sign, ... icant
Addres Applic ion date
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY (C// c � /`
_ JEFFER:ON UNTY HEALTH EPFv1 dT
APPROVER S,Y• ® PERMIT FEE ISSUE DATE RECEIPT NUMBER
!" a Ste• / 7
JUL I 3 , s L.) -2/( /
? 75—
BUILDING OFFICIAL
JEFFERSON COUNTY r
PI ANNINb&HIUb UI:?I
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DRAWING NUMBER
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