HomeMy WebLinkAboutBLD1988-00444 BUILDING PERMIT APPLICATION `
1
Jefferson County Build%$epartment• County Courthouse •Port Tow, 1, Wash.98368 • 385-9141
N E
I. LOCATION: geographic name S W S(DE OF R AD F ET
N E • 11 I 0(c
S W FROM INTERSECTION OF ROAD AND Il ROAD
other specific location or landmark:
PEt DE RIPTION:
� 1•3 ,=2-7 CA)
�
�l j'� Block Subdivision
7C) , I ,J, O ' Tax Number ''A Section Section Township C2/ange
II.TYPE AND COST OF BUILDING-
TYPE OF IMPROVEMENT BUI DING TYPE MOBILITY
KNew building ll,�Single Family ❑New County Resident
❑Addition ❑ 1'ulti-Family Is this structure to serve the residential
number of units
❑Alteration 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 obile Home
❑Moving (relocation) (J Other—Specify ❑YES ❑NO
❑Foundation only
OWNERSHIP USE
❑Full-time Residence
❑Private (individual,corporation,
nonprofit institution,etc.) �J z ❑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 existing building is being changed,enter proposed use. ,
b. Plumbing (.1P 1 /FQ� 7
c. Heating,air conditioning CJ
d. Other (elevator,etc.)
--., • TOTAL COST OF IMPROVEMENT $
•
yc).".9.1)._
III.SELECTED CHARACTERISTICS OF BUILDING f
PRINCIPAL TYPE OF FRAME TYPE OF SEWAG DIMENSIONS
�_. (wall bearing) •Number of Stories
`,,. ❑Masonry g ❑Public or Priva
•Total square feet of floor area,
❑Wood Framendivid I (septic tank,etc.) all floors,based on exterior •
❑Structural steel
a:,
/ dimensions
TYPE OF WATER SUPPLY
❑Reinforced concrete •Total land area,sq.ft. ��
❑Public or w a a company
Other—S cify NUMBER OF OFF-STREET
/_J\(
Individ I (well cistern) PARKING SPACES
Enclosed
CPRINCIPAL TY E OF HEATING FUEL TYPE OF FIREPLACE
w�,, ❑Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY
>3 Electricity Number of bedrooms
❑Coal TYPE OF MECHANICAL
❑Other—Specifyciq
Number of Full
�{ bathrooms
` ` ) � Partial
V. IDENTIFICATION •
Name ,, Mailing Address—Number,street,city and State ( ZIP code T•I.No.
Owner �Q �����-� / /��ye / —
..,.....54,,r-
,ift-,,c,7
2. Po 1✓b I wv
Contractor State License No.
• 3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
` ignat f applicant -, Add ss Appl' ation,e(R'
( 45i-e).--.4-.C( 17-2410'....0---"A •.----).--e)fi..."--- 7/-.7. _A
/(a,i(
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY � .
A p 0 V1�
1 ia
/W
JEFFERSON A .TH DEPART!' NT
APPROVEDBY: [� � P RMJ F,�E ISSUE DATE RECEIPT NUMBER
J�` ERSpN 9 J i S�
J r�r PUN 1 /c7. 7/ �X3/ gcBUILDING OFF1r1501,0 ?gi/S0 ‘,,,,
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