HomeMy WebLinkAboutBLD1988-00395 UILDING PERMIT APPLICATION
Jefferson County Building OW tment• County Courthouse • Port Townseniash.98368 • 385-9141
N E
I. LOCATION: geographic name S W SIDE OF ROAD ET
NE /
S W FROM INTERSECTION OF ROAD AND AD
other specific location or landmark:
PLEGAL I l EST :
Lot Block Subdivisionon /
LD
C 'TM umber %Section Sec ion Township Range
II.TYPE AND COST OF' BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
New building ❑Single Family ❑New County Resident
El ition ❑Multi-Family Is this structure to serve the residential
number of units
❑Alteration or commercial needs of those employed
❑Repair,replacement ElHotel,Motel, Dormitory at either the U.S.Navy's Trident or
number of units Indian Island Facilities?
El Wrecking ( l1(lobile Home
❑Moving (relocation)
El Other-Specify ❑YES ❑NO I
❑Foundation only
CU A) No re.--e_C6 USE
tNOOWNERSHIP ❑Full-time Residence
l ElPrivate (individual,corporation,
�-•� nonprofit institution,etc.) Cl Second Home: Recreation Cabin,etc.
v^ ❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: CI Second Home: Future conversion to
k' Ji 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
tc) in the above cost a. Electrical department store,rental office building,office building at industrial plant.
If use of existing building ik being changed,enter proposed use.
b. Plumbing ?(.1 � --("^1 V( �y�c. Heating,air conditioning U,�,lQ_ ./ /(era ` d
d. Other (elevator,etc.) e�I" ,?-7
• TOTAL COST OF IMPROVEMENT $ f
f/�, III.SELECTED CHARACTERISTICS OF BUILDING -
-4 PRINCIPAL TYPE OF FRAME TYPE OF SEWA DIMENSIONS
❑Masonry (wall bearing) r ski)
( •Number of Stories
ElC''.'t
Public or Private •Total square feet of floor area,
❑Wood Frame ]individual eptic tank, c.) all floors,based on exterior
❑Structural steel J� dimensions
Reinforced concrete TYPE OF WATER SUPPLY •Total land area,sq.ft.
Other-Specify ❑Public or pr. -te company
Individ.:l (well, istern) NUMBER OF OFF-STREET
PE
A A p PARKING SPACES
iivvA
Enclosed
PRINCIPAL TY O HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY
Electricity Number of bedrooms 3
El Coal TYPE OF MECHANICAL
Number of {Full
Oth -Sp if bathrooms
Partial
IV. IDENTIFICATION- .
�} Name Mailing Address-Number,street,city and State �ZIPfcoold/e, Tel.0 No.
I.Owner Pr {raid '4-' 1 ',-7 rV , 4 ersc ) ! p IVW 7J'C�^
�orc ,Tc-4r Tura 6L t�-19- 07a I
2.
Contractor State License No.
3.
Architect
The owner of this building and he undersigned agree to conform to all applicable laws.
>4igna o appli ntAz......7 Ara Applic tiion at
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PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY 0 (_( r( (o i/RkA
JEFFER '•M C UNTY HEA TH DEPARTMENT
APPROVE• BY: ' P RM_I EE ISSUE DATE RECEIPT NUMBER
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APPfO ,
J€FFERSON COUNTY
PUNNING&BLDG DEBT
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