HomeMy WebLinkAboutBLD1988-00428 BUILDING PERMIT`APPLICATION
Jefferson County Building W rtment• County Courthouse • Port Townsetibash.98368 • 385-9141
N E
I. LOCATION: geographic name S W SIDE OF ROAD FEET
S W FROM INTERSECTION OF ROAD AND 9 1 1 CSC � ('fin n ROAD
other specific location or landmark: 1 (,.--_
LEGAL DE CRIPTION: n( JN Q , 2 Area 3
Parcei 4 Lot Block Subdivision
I'I ( 6( 3L /1 Tax Number %Section Section ownship 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
Iteration 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?
❑Wrecking
❑Mobile Home
❑Moving (relocation)
❑Other—Specify ❑YES ONO
❑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
4
permanent residence
COST (Omit cents)
e 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 '(.)rnOc_I I c nq o-P 1 n F) (G e ✓()s•
(�� h E rp ((la
n C1'h� {�?5kLC
c. Heating,airconditioning
d. Other (elevator,etc.) YI�S3( � �Ir� ( ( Sho�r
• TOTAL COST OF IMPROVEMENT $ �)� P�umbl;� 1Yl��l(�S 1 (�C�C�(t1 'oln f
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
Masonry (wall bearing) •Number of Stories
❑ g ❑Public or Private
•Total square feet of floor area,
❑Wood Frame ❑Individual (septic tank,etc.) all floors,based on exterior
�:,,,,) L]Structural steel dimensions
TYPE OF WATER SUPPLY T
El Reinforced concrete • otal land area,sq.ft.
El Other—Specify ❑Public or private company
NUMBER OF OFF-STREET
❑Individual (well,cistern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY
❑Electricity Number of bedrooms
CI Coal TYPE OF MECHANICAL
❑Other—Specify
Number of Full p`)
bathrooms
Partial
IV. IDENTIFICATION-
Name �{ Mailing Address—Number,street,city and State QZIP code Tel.No.
1.Owner Ed Adams s 1 I �tr)C. kLson i PL CQ3(! (1. -
9 533
2. �-f-fP 1 \37 (3 (acne. ) PT R83(06-lS(0l()
Contractor State License No.
Li e C no, , >^I Tn.-L-G 15 t7 G S
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
�ig ature of applicant Address Application date
Witt—. C)1.07,2C1/88
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY
.:i ': PERMIT FEE
IS UE DATE RECEIPT NUMBER
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