HomeMy WebLinkAboutBLD1976-00298 7P7
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JEFFERSON COUNTY COMMISSIONERS 1—Health Dept.
Port Townsend, Washington
BUILDING PERMIT APPLICATION
IMPORTANT — Complete ALL items. Mark boxes where applicable.
Num a street S d' i sion :Lot /I Block ensus tract
LOCATION ,1yj_ e i (ra
OF N S
BUILDING E W side of • fee rom intersection of
(Other local geographic, political, or legal subdivision identification)
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D
A. T PE OF IMPROVEMENT D. PROPOSED USE — For "Wrecking" most recent use
1 ew building R sidential Nonresidential
L I ition(If residential, enter number 12 r ne family 18 I I Amusement, recreational
of new housing units added, if any,
in Part D, 13) 3! _] Two or more family —Enter 19 LJ Church, other religious
3 Li Alteration (See 2 above) number of units— -` 20 L] Industrial
replacement14 L ] Transient hotel, motel,
4 Repair, 21 Li Parking garage
r� por dormitory — Enter number
51 I Wrecking (If multifamily residential, of units- -.tr 221 I Service station, repair garage
enter number of units in building in 15[L Garage 231 I Hospital, institutional
Part D, 13)
6 I I Moving (relocation) 16 r_] Carport 24 Hi Office. bank, professional
7 I I Foundation only 17 L] Other —Specify 25 Li Public utility
26 L]School, library, other educational
B. OWNERSHIP 27 I Stores, mercantile
8 vpaterofit in(indistividual, corporation.) , 28[ ] Tanks, towers
tut ion, etc 29� Other —Specify
_ n
9 j _] Public (Federal, State, or
local government)
C. COST (Omit cents) Nonresidential — Describe in detail proposed use of buildings, e.g., food
processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement $ school, secondary school, college, parochial school, parking garage for
To be installed but not included department store, rental office building, 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.)
11. TOTAL COST OF IMPROVEMENT $, ,
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( ]Masonry (wall bearing) 40 private company ublic or 48. Number of stories
o
3 frame 41. dividual (septic tank, etc.) 49' Total squarers, basedfeet on floort area,
l'` ( p all floors, exterior
32�] Structural steel dimensions
33Li Reinforced concrete H. TYPE OF WATER SUPPLY
Y 50. Total land area, sq. ft j)(
34 Li Other —Specify 42 ('ublic or private company
j'`� K. NUMBER OF OFF-STREET
431 I Individual (well, cistern) PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed
351 ' Gas Will there be central air 52. Outdoors
Oil conditioning?
�, � L. RESIDENTIAL BUILDINGS ONLY
37 ectricity 441 I Yes 45 53. Number of bedrooms
381 I Coal
39[7 Other —Specify Will there be an elevator? Full /
54. Number 1
461 Yes 47 o bathrooms
l(
Partial .
IV. IDENTIFICATION — To be completed by all applicants
Mailing address —Number, street, city, and State ZIP code Tel. No.
Owner 0.e4412'
2.
Contractor State License No.
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws of (name of permit jurisdiction).
nat u oof a icant Address Application`date
DO NOT WRITE IN THIS SPACE — FOR OFFICE USE
Approved by y . Permit fee , Date permit issueded Permit number
$ j—/2'' /,4 o'-� 74