HomeMy WebLinkAboutBLD1978-00352 BUILDING PERMIT APPLICATION 6 1 GA
Jefferson County Building Department• County Courthouse •Port Townsend, Wash.98368 • 385-1310 d
N E
I. LOCATION: geographic name S W SIDE OF ROAD FEET
NE
S W FROM INTERSECTION OF ROAD AND ROAD
other specific location or landmark: C c, /e.. - t' 5�(( ('Ys v S. t" `c\6 i—
LEGAL DESCRIPTION: 37 "C`n-ucc` \ \ OA ►-k\O Y\
Lot Block Subd' is'on
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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
Nil ❑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 64 Mobile Home
%- ❑Moving (relocation)
4 1 ❑Other—Specify CI YES XNO
V4 Foundation only
%
USE
OWNERSHIP
❑Full-time Residence
,Private (individual,corporation,
nonprofit institution,etc.) y Second Home: Recreation Cabin,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.)
• TOTAL COST OF IMPROVEMENT $Y 00 0
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
❑Masonry (wall bearing) ❑Public or Private •Number of Stories
•Total square feet of floor area,
❑Wood Frame ' Individual (septic tank,etc.) all floors,based on exterior
❑Structural steel dimensions 3".- x 1 O
❑Reinforced concrete TYPE OF WATER SUPPLY •Total land area,sq.ft. / ��` ' �`
C v •rl.,�ry�
�]Public or private ' 1pany
❑Other—Specify NUMBER OF OFF-STREET
❑Individual (well,cistern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
kr Oil RESIDENTIAL BUILDINGS ONLY r7
❑Electricity Number of bedrooms Z
El Coal TYPE OF MECHANICAL
❑Other—Specify
Number of Full f
bathrooms
___.-------- Partial
QIV. IDENTIFICATION-
Name Mailing Address—Number,street,city and State ZIP code Tel.No.
d:- 1. RonaAA �cxc3.s 3 / ! 1�c',\p*v\ t�V�- �'(—e m ` \V� q8 3/b 571-HG70
.4 Owner
2.
l Contractor State License No.
‹' 3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Signature applicant 1 Address Application date
/ aT-7 7/2-q/
PLANNING AREA 9 . - FIRE DISTRICT A.)//: . SCHOOL DISTRICT I-/q WATER DISTRICT -
APPROVED BY
OLYMPIC HEALTH DISTRICT:
APPROVED BY: PERMIT FEE ISSUE DATES PERMIT NUMBER
/ / 0 - a /)-677( 220T
/BUILDING OFFICIAL
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