HomeMy WebLinkAboutBLD1988-00355 BUILDING PERMIT APPLICATIO
Jefferson County Buil.Department• County Courthouse • Port To mind, Wash.98368 • 385-9141
N E
I. LOCATION: geographic name S W SIDE OF ROAD FEET
NE
S W FROM INTERSECTION OF ROAD AND t'7 5Q t Q I I e . WSJ` ROAD
other specific location or landmark: P
LEGAL DESCRIPTION:
far cal Lot Block Subdivision
CC( C � 1 '� � ,�
Tax Number 'A Section Section Township Range
II.TYPE AND COST OF BUILDING-
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
New building ❑Single Family
-�. El New County Resident
," ❑Addition ❑Multi-Family Is this structure to serve the residential
El Alteration
number of units or commercial needs of those employed
❑Hotel,Motel, Dormitory at either the U.S. Nav❑Repair,replacement number of units Trident or
❑Wrecking Indian Island Facilities?
Mobile Home
❑Moving (relocation)
❑Other—Specify ❑YES ❑NO
❑Foundation only
USE
OWNERSHIP
❑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
N • Cost of improvement $ processing plant,machine shop,laundry building at hospital,elementary
` y,} 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 �/ j1 / ) I 9f
" 1 c. Heating,air conditioning /` / `/ `�
�,--^ d. Other (elevator,etc
.- • TOTAL COST OF IMPROVEMENT $
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
'? ❑Masonry (wall bearing) El Public or Private.,__ •Number of Stories
❑Wood Frame [ •Total square feet of floor area,
7 Individual(septic tank,.etc.) all floors,based on exterior
❑Structural steel ''-- "" dimensions
� j TYPE OF WATER SUPPLY Total land area,sq,ft.
\���, ❑Reinforced concrete • t�
Other—Specif ❑Public or private company ) •-k.
\fAy�\ u (well,'cistern) NUMBER OF OFF-STREET
\(il 1( ]IndividPARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
CI Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY
Vlectricity
Number of bedrooms
Coal TYPE OF MECHANICAL
Li —Specify Number of Full
bathrooms
Partial I
I
IV. IDENTIFICATION-
Name Mailing Address—Number,street,city and State ZIP code Tel.No.
1. eIle Ads Th ,,- (i-1-G La Dire.nrs='_ ) �>> --_ .t (:-�', _ -3
Owner +
2.
Contractor State License No.
3.
Architect
The owner of this building and t un ersigned agree to conform to all applicable laws.
Signat re o plicant Address
�/` (^D Application date
�C, it/,7 A 1
Ji
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY fill),
cf / /� �JEFF NTY HEA TH DEPARTMENT (/APPRan PERMIT FEE 7E2 oRECEI, T NUMBER
S8 C.
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3 , 50
BU I L D I Ndkor1 I C I Ait1NTY s`
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OC. 13 '87
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APPROVED
JUN 2 3 a6 -- --1�'.ae ��, j � t _
JEFFERSON COUNTY
PtANNMNG&e&OG DEPT
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