HomeMy WebLinkAboutBLD1988-00447 iftBUILDING PERMIT APPLICATION
Jefferson County BuildingW artment• County Courthouse •Port Townsevash.98368 • 385-9141
N E ,r.
I. LOCATION: geographic name SIN SIDE OF l ROAD / ref F T
S W FROM INTERSECTION OF ROAD AND / (� (.�_
other specific location or landmark:1
LEGAL DESCRIPTION: I {///` Cy
Lot Block Subdiv' ' n
E
' ,,9 i't9 5 oac
4
Tax Number Y<Section Section Township Range
II.TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
❑New building ❑Single Family
❑New County Resident
❑Addition ❑Multi-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
❑Mobile Home
❑Moving (relocation)
Other—Specify ll ❑YES ❑NO
❑Foundation only 0-12-1-0---0 -4
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OWNERSHIP CO USE
❑Full-time Residence
❑Private (individual,corporation,
nonprofit institution,etc.) � El Second Home: Recreation Cabin,etc.
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: '`/Ill ❑Second Home: Future conversion to
permanent residence
COST (Omit cents)
Nonresidential— Describe in detail proposed use of buildings,e.g.,food
k+ • Cost of improvement $ processing plant,machine shop,laundry building at hospital,elementary
'N. To be installed but not included school,secondary school,college,parochial school,parking garage for
in the above cost department store,rental o ice building,office building at industrial plant.
a. Electrical If use of existiee
g building is eing changed,enter proposed use.
y b. Plumbing 7573 Ce ram
c. Heating,air conditioning t
d. Other (elevator,etc.)
• TOTAL COST OF IMPROVEMENT $
1
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS )
C, ❑Masonry (wall bearing) •Number of Stories
❑Public or Privats-'�
•Total square feet of floor area,
ood Frame ❑Individual septic tank,etc.) all floors,based on exterior
i dimensions
. M , ❑St uctural steel
ell TYPE,FWATER SUPPLY
❑Reinforced concrete •Total land area,sq.ft.
'.,, ) ❑Other—Specify Public or private company ,
❑Individual (well,cistern) NUMBER OF OFF-STREET
/ PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
❑Oil r'' RESIDENTIAL BUILDINGS 9,NLY
❑Electr ty O Number of bedrooms,,.-'-
❑-C6al
7,9,f!MECHANICAL r'
P•ii Other—Specify Number of
�" Full
bathroom
/ ,' Partial
IV. IDENTIFICATION -
Name Mailing Address—Number,street,city and S to ZIP code Tel.No.
1. Siitt14, /3 ole)c.,
pr f _-
Owner
2.
Contractor State License No.
3.
Architect v
The owner of this building and the undersigned agree to conform to all applicable laws.
gnatur 'qf app'cant Address
Ap/plibation da. .G. ' / ,,,:e#4.<
e_
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY C
JEFFERSON C HEALTH DEPARTMENT
APPRgypB,Y:'�eg PERMIT FEE 7ISSUE DATE RECEIPT NUMBER
JEFFEH.L Cpp �`� CD
°l4ti'NIN '4 8t krlt�rt, 3 S ) ( SBUILDING OFFILJAL 22 1Q� D
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AP ROVED ?- ”
1888,
FFE TM COUNTY
PLASM&BLDG Offii