HomeMy WebLinkAboutBLD1988-00321 BUILDING PERMIT APPLICATION
Jefferson County Buildinggartment• County Cc urthouse •Port Towns.Wash.98368 • 385-9141
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I. LOCATION: geographic name S W SIDE OF ROAD FEET
NE
S W FROM INTERSECTION OF ROAD AND // tit, )5/. I
other specific location or landmark:
LEGAL DESCRIPTION:
Pol r-c t Lot Block vision
.(CJL-z 3o8 Tax Number 'A Section Section Township Range
II. TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
❑New building L O►✓I(L I"Ann ❑Single Family ❑New County Resident
El Addition � ❑Multi-Family Is this structure to serve the residential
number of units
❑Alteration or commercial needs of those employed
❑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
OWNERSHIP USE
❑Full-time Residence
❑Private (individual,corporation,
"tea nonprofit institution,etc.) ❑Second Home: Recreation Cabin,etc.
j ❑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 building is being changed,enter proposed use.
b. Plumbing 1 '�/1 /�
i /per 7 a
-- r
c. Heating,air conditioning 1
d. Other (elevator,etc.) 1::
, e� , \oOC• TOTAL COST OF IMPROVEMENT $ �l ill 'V )
••C III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAG OSA IONS
Masonry (wall bearing) •Number of Stories
❑ g ❑Public or Priva
•Total square feet of floor area,
IDWood Frame jndivid al (septic tank,etc) all floors,based on exterior
❑Structural steel \ dimensions
TYPE QF WATER SUPPLY
❑Reinforced concrete •Total land area,sq.ft.
'Other—Specify Public or private company
1_ - L (?_ NUMBER OF SPACES
IP(ln (J�.{ C '❑Individual (well,cistern) PARKING SPACES
l Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
El Gas Outdoors
�❑/Oil RESIDENTIAL BUILDINGS ONLY
L2�Electricity Number of bedrooms
��✓❑\\\Coal TYPE OF MECHANICAL
Number of Full
❑Other—Specify bathrooms
Partial
IV. IDENTIFICATION - •
Name Mailing Address—Number,street,city and State ZIP code Tel.No.
1. F, �p l—,''
Owner � �
2. �L: • _
—6e+,t in to it State cens o. �� � � ��
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
gnnaature of applicant"";0,
Address Ap I' ation dat
.s.c2
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY1-4 to ci q(C9-7(W
JEFFERSON COUNTY HEALTH DEPARTMENT
APPROAEOV D PERMIT E ISSUE DATE RECEIPT NUMBER
FF'' BB' --75'i
APR 19 3 5-1) 1A7'W 3 S-1
BUILDING OFFICIAL / U
,)lFFERSON COUNTY
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JEFFERSON COUNTY
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