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HomeMy WebLinkAboutBLD1977-00457 BUILDING PERMIT APPLICATION Jefferson County Building Department• County Courthouse • Port Townsend, Wash.98368 • 385-1310 ,/1� 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: i2j, LEGAL DESCRIPTION: '/ Lot Block Subdivision Tax Number Y. Section Section Township Range II. TYPE AND COST OF BUILDING - TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY X New building ,©Single Family ❑New County Resident ❑Addition El Multi-Family Is this structure to serve the residential number of units or commercial needs of those employed ❑Alteration P Y i ❑Hotel,Motel, Dormitory at either the U.S.Navy's Trident or I- El Repair,replacement number of units ♦r Indian Island Facilities? _ ❑Wrecking ElMobile Home 4• ❑Moving (relocation) ❑Other—Specify ❑YES ❑NO El Foundation only i f' USE OWNERSHIP Full-time Residence [}�Private (individual,corporation, El Second Home: Recreation Cabin,etc. nonprofit institution,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 -?.. .5 a60 c. Heating,air conditioning /f 1 2 d. Other (elevator,etc.) <5 7 (4 • TOTAL COST OF IMPROVEMENT $ III.SELECTED CHARACTERISTICS OF BUILDING - PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS /I •Number of Stories �/1(-cf-QfmtQ-.t ❑Masonry (wall bearing) El Public or Private n •Total square feet of floor area, /6 6 U- 1l fv7 ix Wood Frame , Individual (septic tank,etc.) all floors,based on exterior CJ+ ❑Structural steel dimensions /1 0 ❑Reinforced concrete TYPE OF WATER SUPPLY •Total land area,sq.ft. ❑Public or private company �� El Other—Specify NUMBER OF OFF-STREET JZ Individual (well,cistern) PARKING SPACES Enclosed Ct� PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE v i ❑Gas Outdoors ❑Oil / RESIDENTIAL BUILDINGS ONLY L ‘ / K Electricity 7/• ., • Number of bedrooms ❑Coal TYPE OF MECHANICAL ❑Other—Specify Number of Full bathrooms Partial IV. IDENTIFICATION - Name J Mailing Address— Number,street,city and State ZIP code Tel. No. 1\) `S'! �� `�Owner \. 2. IS, i Contractor g License No. Q 3. U 4-2 D .5 Architect JJ i r, The owner of this building and the undersigned agree to conform to all applicable laws. Si na re Address Application date // ig - 677 G PLANNING AREA DISTRICT SCHOOL DISTRICT WATER DISTRICT APPROVED BY OLYMPIC HEALTH DISTRICT:\ ,4Th— APPROVED BY: PERMIT FEE ISSUE DATE PERMIT NUMBER 5 I. 0-- \a: (3 � 1; Q.0 Q-1 BUILDING OFFICIAL The Printery—Port Townsend (S/.s cam, L • �'D -OCT' -�-C.•- •e lC.aa,., ✓n_-7,f P03 E.Angeles, Wall Caroline �at z .'78 OLYMPIC HEALTH DISTRICT Receipt No. ( SEWAGE DISPOSAL PERMIT o 457-8583 COUNTY Submit in Duplicate Builder .0 $ fro' t-'.3EF,F. 802 Sheridan HEALTH DET !Date ` "'"'"?" 6- v cn Port Townsend, Wa" H 385-0722 Installer ,1,�+a 4� 'o H �j! ey r� H 14 t /fir` !.S'r;' C /5Pe( ??.? ~ . ( 2. .- 0 OWNER ADDRESS PHONE DIRECTI'.NS FOR LOCATING SITE A t F/ "4 ItaX,j?c, Ll CI H H Z .'* INSTALL NEW SYSTEM 0 REPLACE SYSTEM 0 PARTIAL REPAIR 0 TANK/DRAINFIELD '"! TYPE OF NO, OF SITE ' • BUILDING ='' � . ' BEDROOMS BASS LENT , - SIZE .,)irA•'� s o DRAINFIELD LENGTH 1 6 c WIDTH ,-,'- DEPTH . #LINES . TANK SIZE `:z_,, GA E 7N TWO COMPARTMENT, H DRAW DETAILED PLOT PLAN BELOW, STUB PLUMBING OUT ABOVE FOUNDATION FOOTING `° + SOIL LOG: ,r+ I "..."...to,'fo te' PA ' toeS...A , fC 'a pQv, ib Ot)ki a c)?\ 0 ANY CHANGE IN BUILDING OR SEWAGE DISPOSAL PLANS, OR LOCATION INVALIDATES THIS PERMIT u.1 UNLESS PRIOR APPROVAL IS OBTAINED FROM THE HEALTH DEPARTMENT, C- ?7� i i /a /2? c� ..\ c. :4. ' .,s�=�__:� APPROVED: DATE_ _ __ INSPECTED PARTI /FINAL DATE SANITARIAN'S COMMENTS-E -4` - 7r 1 ` , �L�Vim..-r �IL.3�—bar'� 1 A � SEE REVERSE SIDE FOR AS BUILT OHD 4-77 #54