HomeMy WebLinkAboutBLD1981-00984 BUI
LDING PERMIT APPLICATION 142 Cal
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 ROAD AND , ROAD
other specific location or landmark: — `/�-'t( s
LEGAL DESCRIPTION: �JU� 7 y lil.JL�I u(ar-- Lot ���� Block - �n J SubdiviSAnk
QTax Number Y.Section Section Township�- Range
^` II.TYPE AND COST OF BUILDING
(` v/ TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
'y yi New building Single Family ❑New County Resident
�� TTT
❑Addition ❑l Multi-Family Is this structure to serve the residential
..... number of units❑Alteration or commercial needs of those employed
c'..i ❑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 ❑YEG ❑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 1 ('
- II 3 ).
c. Heating,air conditioning
d. Other (elevator,etc)
• TOTAL COST OF IMPROVEMENT $ (,(2 pa) a
, III.SELECTED CHARACTERISTICS OF BUILDING -
--- PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
h. ❑Masonry (wall bearing) •Number of Stories
g ❑Publ ate
•Total square feet of floor area,
h Wood Frame I et'),IrY all floors,based on exterior dimensions / i
❑Structural steel
TYPE OF WATER SU L`r 1� l ) •Total land area,sq.ft. 7, A
❑Reinforced concrete
Public or priv t o
❑Other-Specify MBER OF OFF-STREET
❑Individual (well,cis _rn 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
Number of Full
Other- Sp ify bathrooms
I Partial
IV. IDENTIFICATION- _/'�
Name Mailin ddress-Number,street,city and State ZIP code Tel.No�{V
1. i n l i� I �X �7 7
Owner 0 . .l�i I On 1 ni nrUnej) ICJ , 3
Contractor State License No.
3. 1) ,P� , h
..._
Architect ( 53 �(/ qç
The owner of this building and the undersigned agree to conform to all applicable a s.
Signature f applicant ^ Address Applic tionrdat
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3
o APPROVED B
frorn Ka rd
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I APPROVED BY: PERMIT FEE ISSUE DATE PERMIT NUMBER
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