HomeMy WebLinkAboutBLD1976-00301 4f /
JEFFERSON COUNTY COMMISSIONERS 1—Health Dept.
Port Townsend, Washington
BUILDING PERMIT APPLICATION
IMPORTAN — Complete ALL items. Mark boxes where applicable.
Nu 4ed e �r Subdi ion I Lot I,Blgck Census tract
LOCATION_ ���I'�fi " ./_%_i:�- ' �r?` 713'i /v
OF /, )
N �� G/
N S C.
BUILDING
E ide f • feet E W from intersection of
(Other local geographic, political, or legal subdivision identification)
N3 II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D
re) A. TYPE OF IMPROVEMENT D. PROPOSED USE — For "Wrecking" most recent use
1Z 1> 'Irlew building Residential Nonresidential
2[� dition(If residential, enter number of new housing units added, if any, 12 ne family 18 Li Amusement, recreational
) in Part D, 13) 13 Li wo or more family —Enter 19 Church, other religious
`v number of units—————�
V) 31 I Alteration (See 2 above) 20 Li Industrial
������++ 14[-1 Transient hotel, motel,
41 I Repair, replacement or dorrni tory — Enter number 211 I Parking garage
•'"--,rr`--��` 5 Li Wrecking(If multifamily residential, of units- -t• 22 pi Service station, repair garage
enter number of units in building in r--
Part D, 13) 15�] Garage 231 I Hospital, institutional
6 pi Moving (relocation) 16 El Carport 24[L Office, bank, professional
7 I Foundation only 17 � Other —Specify 25L Public utility
26 Li School, library, other educational
B. OWNERSHIP 27 L]Stores, mercantile
8 rivate (individual, corporation, 28 Li Tanks, towers
nprofit institution, etc.)
29 71 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 $1700 /
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
48. Number of stories /
30 L] Masonry (wall bearing) 40 L� Public or private company
31 ood frame 49. Total square feet of floor area,
41 ndividual (septic tank, etc.) all floors, based on exterior /���
E]Structural steel dimensions
33[ i Reinforced concrete H. TYPE OF WATER SUPPLY
34Other —Specify 4 50. Total land area, sq. ft
Li P Y 42 ublic or private company
3 Li Individual (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed
35I I Gas Will there be central air 52. Outdoors
conditioning?
36I I Oil L. RESIDENTIAL BUILDINGS ONLY
37 lectricity 441 I Yes 4;>‹o 53. Number of bedrooms
I I Coal
39I I Other —Specify Will there be an elevator? Full e�
,,,����,, '��/ 54. Number of 1
46[ I Yes 47 I\Lrao bathrooms 11
/�` Partial
IV. IDENTIFICATION — To be completed by all applicants
ame - Mailing address —Number, street, city, and State ZIP code `Tel. No.
1.
Owner649 --�/ . J E5
- // 0 . ,,�� li4ti o c1 i
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).
Si ture of ap 17/5414...Vid Address Application date
pi) 4 7/ 0
DO NOT WRITE /N THIS SPACE — FOR OFFICE USE
App bye by C $ermit /t/) Dae/it issued Permit number /
(/C/ — 76