HomeMy WebLinkAboutBLD1988-00404 'BUILDING PERMIT APPLICATION
Jefferson County Building•tment• County Courthouse • Port TownsenOsh.98368 • 385-9141
N E
I. LOCATION: geographic name S W SIDE OF ROAD FEET
N E
S W FROM INTERSECTION 0 ROAD AND9.IIII;LCNACAfe . ROAD
riother specific location or landmark:
LEGAL DE RIPTION:
of Block Subdivisi
,v 1 Tax Number Y.Section Secti o nshi
l!� P Rang
II.TYPE A DCOSTOFBUILDING -
Rr. TYYPE�OF IMPROVEMENT BUILDING TYPE MOBILITY
Lyj New building ❑Single Family
\ CI New County Resident
❑Addition ❑Multi-Family
, Is this structure to serve the residential
❑Alteration
number of units 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?
\1 ❑Wrecking Mobile Home
(i ❑Moving (relocation)
Other—Specify ❑YES ❑NO
'1/4 '
., ❑Foundation only
OWNERSHIP USE
❑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 $ 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 exing building is being changed,enter pro d use.
b. Plumbing / 0?( --S
c. Heating,air conditioning - t��
/G°l�_ J
d. Other (elevator,etc.) � f ��%/>0(
• TOTAL COST OF IMPROVEMENT $ U L l/7 f
III.SELECTED CHARACTERISTICS OF BUILDING -
--�1 PRINCIPAL TYPE OFFMENSIONS
RAME TYPE OF SEWAG S '
\ ./ ❑Masonry (wall bearing) ❑P lic or Priv •Number of Stories
—�
•Total square feet of floor area, ,
❑Wood Frame ividua (septic tank)etc.) all floors,based on exterior
❑Structural steel dimensions
\ Reinforced concrete YPE. TER SUPPLY
•Total land area,sq.ft.
—Specif Public o private company
herttO c/n ci �l t3 _Q I n ividual (well,cistern) NUMBER OF SPACES
iVc-.� PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
CI Gas Outdoors
El oil RESIDENTIAL BUILDINGS ONLY
-.....1
lectricity Number of bedrooms
❑Coal TYPE OF MECHANICAL
CI —Specify (Number of Full
bathrooms
Partial
IV. IDENTIFICATION- -�
Name r Mailing Address—Numbe(,,street,city and State ZIP code Tel.No.
1. '1.,e.Alit,.Q.J C9C-713 . ,-5; 3 4,,e_ Qtt * 3& ,,S
Owner J 12'1
Cont. .. 4 L
State License No.
It Ol ,.. 6 r -e))
3.
Architect .,
The owner of this building and the undersigned agree to conform to all applicable laws.
/l9nature
of applicant Addreesa" Applic ion da e
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY q /11)
/ J' ? j& /'JEFFERSON COUNTY HEAL.TH DEPAR�'.\1 f4EN`(T('I // G/
APPROVED BY: PERMI FEE ISSUE DATE RECEIPT N BER
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