HomeMy WebLinkAboutBLD1977-00456 BUILDING PERMIT APPLICATION # j ei
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 OF
R�? ANDS ROAD
y�"�--c�'U y�v-- AA — Siff
other specific location or landmark: � _
LEGAL DESCRIPTION: �.-- Cc r )
Lot Block Subdivision
14 3 k• IW
Tax Number /a Section Section Township Range
II.TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
❑New building l/ Single Family ❑New County Resident
Addition ❑Multi-Family Is this structure to serve the residential
❑Alteration number of units or commercial needs of those employed
❑Repair,replacement ❑Hotel,Motel, Dormitory at either the U.S.Navy's Trident or
number of units Indian Island Facilities?
❑Wrecking ❑Mobile Home
❑Moving (relocation)
❑Other—Specify ❑YES ❑NO
❑Foundation only
USE
OWNERSHIP 'Full-time Residence
❑Private (individual,corporation,
nonprofit institution,etc.) ❑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. ..
t: 0 k[)C m -o J
c. Heating,air conditioning
d. Other (elevator,etc.) C—00
• TOTAL COST OF IMPROVEMENT $vOU
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS !
Masonry (wall bearing) •Number of Stories 7
❑ ❑Public or Private
•Total square feet of floor area,
Wood Frame 0 Individual (septic tank,etc.) all floors,based on exterior 51 CG
❑Structural steel dimensions H X y
❑ Reinforced concrete TYPE OF WATER SUPPLY •Total land area,sq.ft.
❑Public or private company
❑Other—Specify NUMBER OF OFF-STREET
Individual (well,cistern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE -
❑Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY
❑Electricity Number of bedrooms
❑Coal TYPE OF MECHANICAL
❑Other—Specify
Number of Full
bathrooms
Partial
IV. IDENTIFICATION -
Name Mailing Address—Number,street,city and State ZIP code Tel. No.
Owner f) k V� —1
2. \ bu c. cl -3 d
Contractor St2,te License No.
i
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Signature of a licant Address 5/6131 J Application date
•&-, - 0� .1jem- - /7a1 Cii3 2 z3/0,"V/tr O,-) (Avg- I- - 17
PLANNING AREA I j FIRE DISTRICT 4" SCHOOL DISTRICT '¢ k) WATER DISTRICT
APPROVED BY
OLYMPIC HEALTH DISTRICT:
APPROVED BY: PERMIT FEE ISSUE DATE PERMIT NUMBER
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BUILDING OFFICIAL
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