HomeMy WebLinkAboutBLD1978-00349 r UILDING PERMIT APPLICATION / h
Jefferson County Building D tment• County Court,' use •Port Townsenfish.98368 • 385-1310 jS
£'jIn'c?� N E i
I. LOCATION: geographic name PL4i T 0 N SIDE OF 4M/e6 ' T 577 1119A-D / 0 FEET
SOW FROM INTERSECTION OFAMINTi/ fFAAD AND�a. t* ROAD
L.—
other specific location or landmark:LEGAL DESCRIPTION: 6 4 -.TL) SW/4) .-- /DLET // MJ LOO/t.;6 77 - A'z/
Lot Block Subdivision
Q q q(0 06101 33 yeti it,-
Tax Number '/a Section Section Township Range
II. TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
Z New building Ul Single Family IA New County Resident
❑Addition ❑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 XNO
❑Foundation only
USE
OWNERSHIP
❑Full-time Residence
APrivate (individual,corporation, Second Home: Recreation Cabin,etc.
nonprofit institution,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 $ J451 c, 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 g,G,a If use of existing building is being changed,enter proposed use.
b. Plumbing /❑w
c. Heating,air conditioning g00
d. Other (elevator,etc.)
• TOTAL COST OF IMPROVEMENT $ /'a y,,0
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
Masonry (wall bearing) •Number of Stories /
❑ g ❑Public or Private -
•Total square feet of floor area,
%Wood Frame ,Individual (septic tank,etc.) all floors,based on exterior
❑Structural steel dimensions 3 I
❑ Reinforced concrete TYPE OF WATER SUPPLY •Total land area,sq.ft. r�
IN Public or private company / ` '2'0
❑Other-Specify NUMBER OF OFF-STREET
❑Individual (well,cistern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
El Gas Outdoors
❑Oil M 4.-- RESIDENTIAL BUILDINGS ONLY
I
inl Electricity Number of bedrooms
❑Coal TYPE OF MECHANICAL
Number of
❑Other-Specify Full * L
bathrooms
�qC Partial
IV. IDENTIFICATION - / �'� o
Name / Mailing Address-Number,street,city and State ZIP code Tel.No.
1. gARN/ C.DZSO/t/ .11Z/74. 6-:''-ifirl-/ --e:kir ,\)k -Wet/ Jg3-':C27-22-
Owner (7 !) ✓�(p .-361
�7 t . � , '`' l77
2. (j3 R.,/ e,OLco n, , /?24 Edge-j,- "L. U, f i 2i-3-t zz.
Contractor State License No.
/I)4 • i
3. t,t)/L(.. 0 L rL11/u5 O!= e)CIST/at) 'coo 6o,J
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Signal re of applipt / Address Application date
(---* -611,624)1.9 /9 / .,;E:,freyvt. ,,, ,t pi iv. /-z --7,
PLANNING AREA gi E DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY \_ow 'r\a.I;j .. 'j< ---" kt-%
OLYMPIC HEALTH DISTRICT: ,
APPROVED BY: PERMIT FEE S / PERMIT NUMBER
g7Ze.::-.--
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f;;Zef.,,/) - c ,12
F-.3. c 0 7 3
BUILDING OFFICIAL
- - rt Townsend -
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PLANjE NRF II
Ft vE C E 1c11: D
E GRS DONE E.
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JUN 2 ')
I" 1984
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