HomeMy WebLinkAboutBLD1980-00433 q /0°
BUILDING PERMIT APPLICATION
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 INTERSECTION OrF/`� ROAD ANDS' l� /, ROAD
other specific location or landmark: 1 r( J�l b \ ( 1 �/ 4�
`. LEGAL DESCRIPTION: -)48 io7 (2 Orrnr 8 t_' c'i-n t .dPY
L\., Lot Block Subdivision
i Lk
Tax Number Y.Section _ 31- 0
Section Township Range
II.TYPE AND COST OF BUILDING
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
A� New building 'Single Family ❑New County Resident
\ �. ❑Addition 0Multi-Family Is this structure to serve the residential
VVv number of units❑Alteration 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
❑Moving (relocation) ❑Other—Specify El YES
"I�•foundation only
7� USE
OWNERSHIP pXFull-time Residence
Yj•Private (individual,corporation,
nonprofit institution,etc.) ❑Second Home: Recreation Cabin,etc.
El Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: ❑Second Home: Future conversion to
permanent residence
, a COST (Omit cents)• Cost of improvement $ Nonresidential— Describe in detail proposed use of buildings,e.g.,food
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.
C.
a. Electrical If use of existing building is being changed,enter proposed use.
( j�{ b. Plumbing
...J c. Heating,air conditioning
l
d. Other (elevator,etc.)
• TOTAL COST OF IMPROVEMENT $ 22+ r M
III.SELECTED CHARACTERISTICS OF BUILDING/-
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS I
❑Masonry (wall bearing) ❑Public or Private
•Total square feet of floor area,
[]Wood Frame Individual ( ic t •Number of Stories
etc.) all floors,based on exterior
dimensions H+0
structural steel
❑Reinforced concrete TYPE OF WATER SUPPLY •Total land area,sq.ft. W/Y�/^
g Public or privat rkta J
❑Other—Specify NUMBER OF OFF-STREET
I❑Individual (well,cistern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
El Gas Outdoors 2-
❑Oil ........-- RESIDENTIAL BUILDINGS ONLY i
Electricity Number of bedrooms
❑Coal TYPE OF MECHANICAL
{ 1
Number of Full
❑Other— Specify bathrooms Partial
I
IV. IDENTIFICATION -
Name Mailing Address— Number,street,city and State ZIP code Tel.No.
Wit. Q,lfix?r-- cL \ 1� 1504 1 . 3-4359
Owner 1 r� ' I , 629
r, 2 ( ./�/
Contractor ' State License No.
3.
Architect
... owner of this building and the undersigned agree to conform to all applicable laws.
Signature of applicant Address Application date
/Ci /�..�'-• /, �N/ 177
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'0 PLANNING AREA_ �—FIRE9STRICT t SCHOOL DISTRICT �G? WATER DISTRICT
3 APPROVED BY N ,�
Cr.
p JEFFERSON COUNTY HEALTH DEPT � �` �
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7 \. lII
I APPROVED BY: PERMIT FEE ISSUE DOE PERMIT NUMBER
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-c BUILDING OFFICIAL