HomeMy WebLinkAboutBLD1989-00487rA BUILDING PERMIT APPLICATION
Jefferson County Buddin-epartment• County Courthouse •Port Towns Wash.98368 • 385-9141
I. LOCATION: geographic name S W SIDE OF JaS ✓l _ROAD FEET
N E a
S W FROM INTERSECTION OF ROAD AND_ �/ J�Q-(I, W ROAD
other specific location or landmark: ((
LEGAL DESCRIPTION:
Lot B ck Subdi pi
f� Q1 G�Ilea st� / 30
Oct O l 1V T um /.Section Section TownshipRa e
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II.TYPE AND COST OF BUILDING-
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
0 New building ❑Single Family
❑New County Resident
ddition ❑Multi-Family
Is this structure to serve the residential
❑Alteration number of units or commercial needs of those employed
❑Hotel,Motel, Dormitory at either the U.S.Nav
6 ❑Repair,replacement number of units y's Trident or
9 ❑Wrecking Indian Island Facilities?
Mobile Home
❑Moving (relocation)
Other —Specify ❑YES NO
❑Foundation only
—4) USE
OWNERSHIP
❑Private (individual,corporation, LJ Full-time Residence
nonprofit institution,etc.) -1 l 4 ❑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.
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b. Plumbing , y 3
L
c. Heating,air conditioning lr- (\
d. Other (elevator,etc) 01
• TOTAL COST OF IMPROVEMENT $
III.SELECTED CHARACTERISTICS OF BUILDING - (1„,,\
,,r
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE i • :4 11/4,4 I (N DIMENSIONS 1
❑Masonry (wall bearing) ❑Public or Private •Number of Stories f
❑Wood Frame "i •Total square feet of floor area, (((
lndividu (septic tank,qtc.) all floors,based on exterior
❑Structural steel / dimensions
TYPE OF WATER SUPPLY
❑Reinforced concrete •Total land area,sq ft `(°
Other—Spe fy n ,_ ndivi. al (well,cistern)❑_,/Public or pr. - e company
0/14Lo U -C p�l NUMBER OF OFF-STREET
Ye(( / PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
RESIDENTIAL BUILDINGS ONLY
Elli Electricity Number of bedrooms
❑Coal TYPE OF MECHANICAL
❑Other—Specify Number of Full
bathrooms
Partial
IV. IDENTIFICATION -
•
Name Mailing Address—Number,street,city d State ZIP code Tel.No.
1.
Owner � q620 ---iiiiit q(ort(-_z_ (A)c--t 9to? -- 1/9:
� �C1-
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Ner .,._,_,511/0)/(_,Q 0, (A.°0 90-LCIZ arAe '9,00, __Ws/
gr,....ciajo,„4,j si-dte_b.cei,„,.-:- f--, . .__
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Sig of applicant Address Applicatio date
! .A.--..
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY 0 C
dre/nh c e e. ?�l 3y
JEFFERSON COUNTY HEALTH DE ARTMENT
APM I�R0.VF,0PP$$.$YO P.FRMI EE ISSUE DATE RECEIPT NUMBER
tr' 11'''' 76 /J
5 (: (€:, c).__?
2--). 40q,„
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BUILDING OFFICIAL
JEFFERSON COUNTY '
PLANk,Nb&BLDG DEPT — •
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APPROVED /71714
APR 2 8 1989 /372.t.
JEFFERSON COUNTY
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PLANNING&BLDG DEFT
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41264-17k,
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