HomeMy WebLinkAboutBLD1978-00351 BUILDING PERMIT APPLICATION
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Jefferson County Building Department• County Courthouse •Port Townsend, Wash.98368 • 385-1310
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I. LOCATION: geographic name S W SIDE OF ROAD FEET
NE
S W FROM INTERSECTION OF ROAD AND ROAD
other specific location or landmark: /-4" Yfi/ y)�
LEGAL DESCRIPTION: ;V , i
ti
Lot Block Subdivision
•
Tax Number /<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
❑Alteration number of units or commercial needs of those employed
❑Hotel,Motel, Dormitory at either the U.S.Navy's Trident or
❑ Repair,replacement
number of units Indian Island Facilities?
❑Wrecking ❑Mobile Home
El Moving (relocation) Other—Specify
CI YES CI NO
Foundation only
C et,c v
OWNERSHIP `� — S t.s o USE
❑Full-time Residence
Nterivate (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
c. Heating,air conditioning d. Other (elevator,etc.) 2/F0 "St �.
• TOTAL COST OF IMPROVEMENT $ t 9;2_O
III.SELECTED CHARACTERISTICS OF BUILDING - y( / ;.0
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
❑Masonry (wall bearing) •Number of Stories
— — •Total square feet of floor area,
Wood Frame Individual (septic tank,etc.) all floors,based on exterior dimensions � C��/1
❑Structural steel
TYPE OF WATER SUPPLY
❑ Reinforced concrete �^ , •Total land area,sq.ft. yy1y�..,�//�'
El Other—Specify ublic or private company �(�C iC
NUMBER OF OFF-STREET
❑Individual (well,cistern) PARKING SPACES
Enclosed
RINCIPAL TYPE OF HEATING FUE TYPE OF FIREPLACE
Gas Outdoors
❑Oi RESIDENTIAL BUILDINGS ONLY
❑Electri — Number of bedrooms
El al TYPE OF MECHANICAL _
Number of Full
Other—Specify
f ��
bathrooms
Partial
IV. IDENTIFICATION-
Name D /� Mailing Address Number,street,city and State t /�{ZIIPP code Tel.No.
6 1. f�`r FL R l 1SC)c`(Y't. 4� ) 1 1 d W StiP��i Y' O3 3 a,/'J/o
Owner -7
2. `'� C�'�t.
Contractor State License No.
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Signature of applicoit Address Application date
PLANNING AREA p _ FIRE DISTRICT 6 SCHOOL DISTRICT S C ) WATER DISTRICT
APPROVED BY 6 Qe • ram , � .)c..ticuvs. 3 —7 0
OLYMPIC HEALTH DISTRICT:
APPROVED BY: PERMIT FEE ISSUE ATE PERMIT NUMBER
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BUILDING OFFICIAL
t2 6 g 3 --mac ;� Z
The Printery—Port Townsend
90I E7 L"ail"f; e _.-__--._-Qla mTC \i i'T DY:i fI.r'".i Permit 00o. 3 sir '
2o..t: Angeles, Wash. SEWhCG DISPOSAL P RMIT t1.PPL=A ION
aibmit In Uu. l.i.ate Builder
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Port Tcornsr:�d, WS311 Date 1 rr . ��
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D tEfiTIC.NS FOR TZCATLVG SI^ \-- .:. '\ a lo ��.....A \ A.`. �4 J'�. - EL�! ..LaziLa
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APpLIL P TION IS HEREBY. MADE TO: INSTALL NEW SYSTEM PAIR EXISTING SYS
TYPE OF BUILD G NO. Or BEDROC iS ( SITE SIZE NAME OF INSTALLER
447
DRAINFIELD LENGTH \o p WIDTH 3 a DE 'ES ci�E� PTIC TANK SIZE
DRAW A DETAILED PLOT PLAN BELOW. SEE INSTRUCTIONS. SOIL TYPE c Sa\\
C...\. V.:IN 'e•t.I. .:(34 9
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ANY CHANGE IN BUILDING OR SEWAGE DISPOSAL PLANS, LOCATION OR SITE, INVALIDATES THIS
PERMIT UNLESS PRIOR APPROVAL OBTAINED FROM THE HEALTH DEPARTMENT.
TE OF INSTALLATION SIGNATURE OF APPLICANT-SC ` .--C 6�
It ,/" DATE / /02 6 70, INSPECTED BY Qom\ �a s.s `��' J E 2//8/(
SANITARIAN'5 COMMENTS:
6.4s � t /a-57b_
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I CERTIFY THAT ySTEM, IAr THE MANNER APPROVED BY THE HEALTH
DEPARTMENT '--lit AAV / DATE
INS LLERS
OHD 6-75 de :'G -tdeo.. %7/is- E,_ - -
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