HomeMy WebLinkAboutBLD1988-00416 BUILDING PERMIT APPLICATION
Jefferson County Buildinrpartment• County Courthouse • Port Towns.Wash.98368 • 385-9141
N E
I. LOCATION: geographic name S W SIDE OF ROAD FEET
NE
S W FROM INTERSECTION OF ROAD AND C PJ= M'r *.11o�t ROAD
other specific location or landmark: C>L1 r ch i-v2_ { 44. 7
LEGAL DESCRIPTION: 1 1 q 9 (>i.lt-tr�a
Lot Block Subdivision
9g/ _96/_ 4/2? /G 2,.5-eN, zc3
Tax Number 'A Section Section Township Range
II.TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING_ TYPE MOBILITY
❑New building *Ingle Family ❑New County Resident
❑Addition (❑Multi-Family Is this structure to serve the residential
number of units or commercial needs of those to ed
Iteration — P Y
1.
C'i-iocei,iviocel, Dormitory at either the U.S.Navy' rident or
Repair,replacement
number of units Indian Island Faci es?
❑ ecking ❑Mobile Home
❑Moving (relocation) ❑Other-Specify ❑Y ❑NO
❑Foundation only /r'�
IAv-tY -T P-x't3TK1 Metage
g` "1-15 S t slit - USE
OWNERSHIP FPrt�LL J s.
ll .it0 c„142/�c�jlr t
❑Full-time Resider
J ❑Private (individual,corporation,nonprofit institution,etc.) ❑Second e: Recreation Cabin,etc.
{�""° ❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: 3 ❑ cord 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 /6)l3 Z `- �� 17(7
c. Heating,air co tioning (
d. Other evator,etc.)
• Tti AL COST OF IMPROVEMENT $
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
/
❑Masonry (wall bearing) •Number of Stories
❑Public or Private
•Total square feet of floor area,
Wood Frame Individual (septic tank,etc.) all floors,based on exterior
Li Structural steel dimensions 2
(� TYPE OF WATER SUPPLY
�y ❑Reinforced concrete •Total land area,sq.ft. ...�{ ` �/.,.,
Arublic or private company 0(.1r- G®d 0
'- ❑Other-Specify NUMBER OF OFF-STREET
-"-s-- ,Individual (well,cistern) PARKING SPACES
i.41
—
Enclosed
-' PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE -
S ❑Gas - Outdoors
`�`, ❑Oil RESIDENTIAL BUILDINGS ONLY C_Mitot//4e�"/04 ig
Electricity - Number of bedrooms }
❑Coal TYPE OF MECHANICAL GQd{t l4, F�"f`°Je
❑Other-Specify Number of {Fllu Xl (i4j Di-6941/
bathrooms ll
(�{ / Partial �/
`yJ _ /1
IV. IDENTIFICATION -
-."1 Name [� ^f
Mailing Address-Number,street,city and State ZIP code Tel.No.
1. J��"1"Ic'lr tRUl 1s � NiNie L Si- 03
mr. Owner ` /
� - — — Y�,.Leowen.. W cm. 9866/ y27°
Contractor State License No.
'3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Signature ap cant 7.: .- Address Application date
PLANNING AREA FIRE DISTRICT__--- SCHOOL DISTRICT WATER DISTRICT
APPROVED BY 00 1/ s7`- V� eitG_ Gf4
JEFF �rRD d CCU HEALTH DEPARTMENT
APPR R/e L;fit PERMIT FEE IS UE D TE RECEIPT NUMBER
MAY g ' E �. 3 S`' / /
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