HomeMy WebLinkAboutBLD1976-00300 ,
JEFFERSON COUNTY COMMISSIONERS 1—Health Dept.
Port Townsend, Washington
BUILDING PERMIT APPLICATION
IMPORTANT — Complete ALL items. Mark boxes where applicable.
Nu jd�strreet S division !Lot/ I Block us tract
LOCATION r-�'INl/YV\Qa O i (O
OF N S N S.
OBUILDING E W side of E W from intersection of
K) (Other local geographic, political, or legal subdivision identification)
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D
\4 A. TYPE OF IMPROVEMENT D. PROPOSED USE - For "Wrecking" most recent use
Ze+y building Residential Nonresidential
2[[ 1 Addition(If residential, enter number 1 ne family 18 j 1 Amusement, recreational
of new housing units added, if any, _
in Part D, 13) 13[_] Two or more family -Enter 19 j Church, other religious
number of units------1.-
3 Li Alteration (See 2 above) 20 1 Industrial
4 Repair, replacement 14[_I Transient hotel, motel, 21 I Parking garage
[L P or dormitory -Enter number
5 Li W• recking(If multifamily residential, of units- ->. 22[ Service station, repair garage
enter number of units in building in 15 L-I Garage 231 Hospital, institutional
Part D, 13)
16 Li Carport 241 Office, bank, professional
6 Ii M• oving (relocation)
7 Li Foundation only 17 L__ Other -Specify 251 Public utility
26 Li School, library, other educational
B. OWN ERSHIP 27 Li Stores, mercantile
riv'5te (individual, corporation, 28 Li Tanks, towers
/ Tan profit institution, etc.)
29 j I Other -Specify
9[_] 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 $p:3(')C\G
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 J
30[I_ ] Masonry (wall bearing) 40[-1 Public or private company 48. Number of stories
3 od frame 49. Total square feet of floor area,
41 ividual (septic tank, etc.) all floors, based on exterior
Structural steel dimensions la
331 I Reinforced concrete H. TYPE OF WATER SUPPLY
34 Li Other -Specify 42 ublic or private company 50. Total land area, sq. ft
K. NUMBER OF OFF-STREET
43'l 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
conditioning?
36 Li Oil L. RESIDENTIAL BUILDINGS ONLY
37 ctricity 441 [Yes 45><o 53. Number of bedrooms
381 [ Coal
39[i O• ther -Specify Will there be an elevator? Full I
� 1 .� 54. Number of f
46[ [Yes 47 1v0 bathrooms l` i\
JJ�� Partial
IV. IDENTIFICATION — To be completed by all applicants
ne Mai l-g address -.Numb street, cit , and State ZIP code Tel. No.
1. 0 '�e' / e� �C,C.2----
Owner q '��1i9-tr [ t,✓ 1‘
2.
Contractor State License No.
3.
Architect
The • - . his buildi and the undersigned agree to conform to all applicable laws of (name of permit jurisdiction).
Si.:nature ofant Address Ap lication date
t)DO NOT WRITE IN THIS SPACE — FOR OFFICE USE
Appro • b Permit fee �_/S 0 Date permit issued Permit numby
•.X t. $ 1J.51 /7— 7 / 72__