HomeMy WebLinkAboutBLD1988-00437 BUILDING PERMIT APPLICATIOAL
Jefferson County Buil")Department• County Courthouse •Port To d, Wash.98368 • 385-9141
N E •
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I. LOCATION: geographic name S W SIDE OF FEET
NE
S W FROM INTERSECTION OF ROAD AND �. �R AD )1Ad— i ROAD
other specific location or lanrk: ! ( /
L�E PTION:
Lot Block Subd' isi r ) ki
61
( / O Tax Number '%Section Section Township Range
II.TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
crec4.,,,77 building ❑Single Family
❑New County Resident
❑Addition ❑Multi-Family Is this structure to serve the residential
number of units
El Alteration or commercial needs of those employed
El Repair,replacement
ElHotel,Motel, Dormitory at either the U.S.Navy's Trident or
number of units Indian Island Facilities?
❑Wrecking El Mobile Home
El Moving (relocation)
Other—Specify ❑YES ONO
❑Foundation only '''�
C V U
OWNERSHIP USE
❑Full-time Residence
❑Private (individual,corporation,
nonprofit institution,etc.) /� CI Second Home: Recreation Cabin,etc.
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: l El 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 existing building is being changed, nter propos use.
b. Plumbing (gV'@ /_ //�
c) y � `f 000 �Q( `�l
c. Heating,air conditioning
d. Other (elevator,etc.)
ci) .
• TOTAL COST OF IMPROVEMENT $
ctIII.SELECTED CHARACTERISTICS OF BUILDING -
\ol �
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE 6Fsu DIMENSIONS
(
❑Masonry (wall bearing) •Number of Stories
r ❑Public or Priv
�__/ •Total square feet of floor area,
ood Frame ( V9.Los_lividu (septic tan ,etc.) all floors,based on exterior
XJ ructural steel dimensions
TYPE OF WATER SUPPLY
El Reinforced concrete •Total land area,sq.ft.
El Other—Specify ❑Public or private comp
NUMBER OF OFF-STREET
❑Individual (well,c' ern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING F
TYPE OF FIRE ACE
I ❑Gas Outdoors
C` ❑Oil RESIDENTIAL BUILDING LY
3 ❑Electricit Number of bedroo
CI Co PE OF MECHANICAL
ther—Specify
Num of Full
rooms
Partial
IV. IDENTIFICATION-
Name Mailing Address—Number,street,city and State ZIP code Tel.No.
Owner p�� G /
2.
Contractor State License No.
3.
Architect , '
The owner of this building and t undersigned agree to conform to all applicable laws.
• natur Of lican A� Address Applic tion date
'''--1, c' ____Ce/ir\L_ 7 ( .5 _
PLAN NG AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY
0lc_ 4 e..._,„,..,,l
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C NTY HEALTH DEARTfvMENT
PERMITFEE ISSUE DATE RECEIPT NUMBER
V 90,coo
FICIAL J•� �� •
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