HomeMy WebLinkAboutBLD1975-00216 JEFFERSON COUNTY COMMISSIONERS
Port Townsend, Washington
BUILDING PERMIT APPLICATION
IMPORTANT — Complete ALL items. Mark boxes where applicable.
N tuber n str t Subdivision I Lot I Blot Census tract
LOCATION S � 2 --3-7 Thu ►vi
1—Health Dept.
i GU 0.6 a /Y\
OF S N S 9—A.-JO'?• g."0 .
BUILDING E W side of • feet E W from intersection of
(Other local geographic, political, or legal subdivision identification)
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D ,
A. TYPE OF IMPROVEMENT D. PROPOSED USE - For "Wrecking" most recent use
�� 1 ew building Residential Nonresidential
2 Li Addition(If residential, enter number 12 ne family 18[J Amusement, recreational
of new housing units added, if any,
V in Part D, 13) 13 i 1 Two or more family -Enter
number of units------0- 19 rii C• hurch, other religious
(�, 3I I Alteration (See 2 above) 20 F� Industrial
V" 4 Repair, replacement 14[ ] Transient hotel, ter n 21 LI P• arking garage
I P P or dormitory - Enter number
51 I Wrecking(If multifamily residential, of units- 22 Li S• ervice station, repair garage
enter number of units in building in 15[ i Garage 23[ I Hospital, institutional
Part D, 13)
6 I I Moving (relocation) 16 L_] C• arport 24 Li Office, bank, professional
17 L_j O• ther -Specify 251_ 1 Public utility
7I I Foundation only
26 Ell School, library, other educational
B. OWNER HIP 27 1 I Stores, mercantile
Private (individual, corporation, 281 I Tanks, towers
!} nprofit institution, etc.)
29 1 I Other -Specify
),,� 9 ] Public (Federal, State, or
local government)
(Omit cents) Nonresidential - Describe in detail
C. COST proposed use of buildings, e.g., food
processing plant, machine shop, laundry building at hospital, elementary
* lo, Cost of improvement $ school, secondary school, college, parochial school, parking garage for
'---, department store, reofficentalbuilding,
ena
To be installed but not included office building at industrial plant.
in the above cost If use of existing building is being changed, enter proposed use.
�-� a. Electrical
�`� b. Plumbing
c. Heating, air conditioning
d. Other (elevator, etc.)
Q
11. TOTAL COST OF IMPROVEMENT $4.5 36,-/
III. SELECTED CHARACTERISTICS OF BUILDING — For new buildings and additions, complete Parts E — L;
for wrecking, complete only Part j, for all others skip to IV.
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS
30 Li Masonry (wall bearing) 40 Li Public or private company 48. Number of stories
31 _ sod frame ., dividual (septic tank, etc.) 49• Total floors,squ based feet ono xter area,
f"` ( p all exterior
32 pi S• tructural steel dimensions a0G
33Li Reinforced concrete H. TYPE OF WATER SUPPLY
34 El O• ther -Specify 421 1 Public or private company 50. Total land area, sq. ft
43�I Individual (well, cistern) K. NUMBER OF OFF-STREET
�`'� PARKING SPACES n -
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed o�C�
351 I Gas Will there be central air 52. Outdoors /
conditioning?
36I I Oil L. RESIDENTIAL BUILDINGS ONLY
3j �lectricit 441 Yes 40 53. Number of bedrooms
8I 1 oal
39 1-7 O• ther -Specify Will there be an elevator? 1 Full
54. Number of
461 'Yes 47 o bathrooms
Partial
IV. IDEN TIFICATION — To be completed by all applicants
Name Mailing address -Number+ street, city, and State • ZIP code Tel. No.
,. �,.�c.. , g . �%n-rr�-�� i . ..--51-- ., -43 7
Ownern
7, G.c--aCT/
2.
Contractor tate License No.
k,.."
3. i may,-_ i ��c 3�'.N
Architect /‘710
The owner of this building and the undersigned agree to conform to all applicable laws of (name of permit jurisdiction).
Signature of api4-1
iant Address Application dateat
r07VnVnll�, /r//`J 5 J�/ /
DO NOT WRITE IN THIS SPACE - FOR OFFICE USE
Approved y - Permi fee 0
Date p mit issue Permit number // 17
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