HomeMy WebLinkAboutBLD1978-00350W BUILDING PERMIT APPLICATION 'a I
Jefferson County Building Department• County Courthouse •Port Townsend, Wash.98368 • 385-1310
N E
I. LOCATION: geographic name S W SIDE OF ROAD FEET
NE
S W FROM INTERSECTIO OF ROAD Air D ROAD
other specific location or landmark: ��� LL � ( o` MS) / �ill-- .1 / U��_/�
LEGAL DESCRIPTION: _t:e.e_ii--/
_ Lot (... II /�glock Subdivision p
Tax ''� p�umber %Section Section Township Range
II. TYPE AND COST OF BUILDING - .
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
ew 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
El 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 El YES XNO
❑Foundation only
USE
OWNERSHIP ull-time Residence
, 0rivate (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 $ 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 Oldij-/, X4- -e _________
c. Heating,air conditioning
d. Other (elevator,etc.)
• TOTAL COST OF IMPROVEMENT $ / `/ -)r)6
III.SELECTED CHARACTERISTICS OF BUILDINGJ -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
❑Masonry (wall bearing) •Number of Stories
❑Public or Private •Total square feet of floor area,
ood Frame ividual (septic tank,etc.) all floors,based on exterior /4 k r]°
ElStructural steel dimensions
❑ Reinforced concrete TYPE OF WATER SUPPLY •Total land area,sq.ft.
❑Other-Specify ElPublic or rivate company
NUMBER OF OFF-STREET
ividual (well,cistern)
PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY" iectricity Number of bedrooms C3/ll
❑Coal TYPE OF MECHANICAL
❑Other-Specify l
/ Number of Full )
bathrooms I
Partial
IV. IDENTIFICATION -
Name Mailing Address-Number,street,city and State ZIP code Tel. No.
1. } / 9. : ,a 72--
Owner /ft.)2 QJ Cl -''^ -Cf/l�yJ �0LU / (G L)
2. �. t
Contractor tate License No.
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Si ture of applic� Address Application date
AL PO( PO x 338 Oh l ►-ic e.,.. 17-7/
Al
PLANNING AREA FIRE DISTRICT / SCHOOL DISTRICT 47 WATER DISTRICT
APPROVED BY ( /
OLYMPIC HEALTH DISTRICT
APPROVE BY: PERMIT FEE ISSUE DATE PERMI UMBER
,,,,,,, a_,.
,_.... ,.._ , ,..„ „..
BUILDING OFFICIAL `-' -v 6 1
The Printery-Port Townsend
_471/ JEFFERSON COUNTY HEALTH DEPARTMENT
802 SHERIDAN AVENUE
INSTALLER se / PORT TOWNSEND, WASHINGTON 98368 RECEIPT NO. / 7
(206) 385.0722
BUILDER DATE 3- 7`7 8
SEWAGE DISPOSAL PERMIT _
Submit in Duplicate
✓v;s —A o Y f pc, 86 3 38 eh i frytac u kn. 7 3 Z C/6o
Owner /e of r-✓ 5/2.6-,t- Address . Phone r-
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07 kn_i. !e 5 w co I N 1;1, Q cam_ o-,-., C -- gd D
Directions for locating site -_ r-
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Ir/2 ✓ 0ti C,( 01, �r- l--t V G ! f"'/ 0?f'-et' /::- vY`- ���
n
DO
INSTALL NEW SYSTEM R' REPLACE SYSTEM ❑ PARTIAL REPAIR Ll TANK/DRAINFIEL ��_ 8
O
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TYPE OF r NO. OF SITE
BUILDING Yo►J• t BEDROOMS a BASEMENT SIZE F,..;<- Cl)IC"- cn
DRAW DETAILED PLOT PLAN BELOW. STUB OUT PLUMBING ABOVE FOUNDATION FOOTING co n
SOIL LOGS .ci4,-,A ` L.tnt,.iDel o 7
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-IN ' ,_ (j l/ fie N /o c ✓ W m
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Dig two holes per site. (min.) n
4' deep - 2' dia. - 50' apart & flag APPLICANT
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Drainfield Length/c)() 4 Width 2 Depth_ C) # Lines Tank Size/C'Y' Gal- O
COMMENTS: 0) of69a`3e,.,� /yaie S ,F,e -e..=„ E•- , , (TWO COjV1PARTMENTS) D
at.. Arj9CW L_<<JE S X ec/cc_ /- c?ew 1-S^ SA e f E p m
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APP OVEDe7
DATE INSPECTED PARTIAL/FINAL DATE
I certify that this system was installed in a manner approved by the Health Department.
INSTALLER'S SIGNATURE DATE DATE INSTALLED
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