HomeMy WebLinkAboutBLD1988-00446 UILDING PERMIT APPLICATION
Jefferson County Building rtment• County Courthouse •Port Townsenash.98368 • 385-9141
N E
I. LOCATION: geographic name S W SIDE OF ROAD FEET
N E S W FROM INTERSECTION OF ROAD AND � J �p/�f 0i / e- Pt; ROAD
other specific location or landmark:
LEGAL DES WON: �?t' '// lLot Block y/ Su13L—
vise$y�,n lJ `✓a
fill I 1�/� 5/�, CCU �- !�" ( ��J
( �� Taff Number 1%Section Section Township Range
II.TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
New building ❑Single Family ❑New County Resident
❑A dition ❑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?
❑Wrecking ❑Mobile Home
❑Moving (relocation) ,.. "Other—Specify
❑YES ❑NO
❑Foundation only
f
USE
OWNERSHIP
❑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 uses off existing building/ is being changed,enter pr sed use. f rrr���
b. Plumbing r c -x, l (Q Y e [��//� F-!
(�''�.,7� �C/ 111 l I"�
c. Heating,air conditioning /
d. Other (elevator,etc.)
•
• TOTAL COST OF IMPROVEMENT $
III.SELECTED CHARACTERISTICS OF BUILDING -
C . PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPO 16 DIMENSIONS j
•Number of Stories !J
❑Masonry (wall bearing) ❑Pub ivate •Total square feet of floor area,
•('Wood Frame individual (septic tank,etc.) all floors,based on exterior •
tructural steel dimensions
• ❑Reinforced concrete TYPE OF WATER SUPPLY •Total land area,sq.ft.
❑Public or private Company
❑Other—Specify - NUMBER OF OFF-STREET
C:]ritlivedual (well,cistern) PARKING SPACES
Enclosed
,<..... PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY
r y
❑Electricity Number of bedrooms ----
TYPE OF-MECHANICAL
❑Cgat `
-❑Other—Specify
Numberpf Full
ttaThr6Orns
Partial
IV. IDENTIFICATION-
Name Mailing Address—Number,street,city f d State ZIP code Tel.No.
1. F '' J C. 472,( 0iel e PT e `F2, ��' /37--
Owner
r� LPL. Q?(
2. inu.H .
Contractor State License,No.
liV)ra
1 4.5„,
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Se natur f applicant / Addess Applicat' n dam,
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY A/A CikK.rd:=7—_
JEFFERSO HE TH DEPARTMENT
APPROI O
7jPERMIT FEE ISSUE DATE RECEIPT NUMBER
7. ,00
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