HomeMy WebLinkAboutBLD1985-00042 BUILDING 4111/ .,RMIT APPLICATIC
Jefferson County Building Department • County Courthouse • Port Townsend, trash 95'368 • 385 1310
• N E FEET
I. LOCATION: peopraphrc name S W SIDE OF ROAD
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S W FROM INTERSECTION OF ROAD AND ✓�` �/, /
ROAD'''Q -.17d6/2.1 2-2-)
Other specific location or landmark � /�
LEGAL DESCRIPTION: ;` e �
/ot Block SubdtvisiO . -,. (z_z__
RI 7lV9 'Ji Tax Number Y.Section �g ion Township Range
II.TYPE AND COST OF BUILDING
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
Single Family ❑New County Resident
®.tJew building
Addition ❑Multi-Family �Is this structure to serve the residential
number of units or commercial needs of those employed
❑Hotel,Motel, Dormitory
❑Alteration at either the US.Navy's Trident or
0 Repair,replacement number of units Indian Island Facilities?
O Wrecking 0 Mobile Home
p Moving(relocation) Eg Other—Specify ❑YES ONO
❑Foundation only 904, %
USE
OWNERSHIP ❑Full-time Residence
— 0 Private(individual,corporation, „ ❑Second Home: Recreation Cabin,etc.
nonprofit institution,etc.)
❑Public(Federal,State or local 901/0 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
S 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 �7 of ^y(ItiCJ ---e/uo 0 jP/0
t
c. Heating,air conditioning
d. Other (elevator.etc.)
• TOTAL COST OF IMPROVEMENT Sa -
III.SELECTED CHARACTERISTICS OF BUILDING -
DIMENSIONS I
PRINCIPAL TYPE OF FRAME
Zf'...rtyr,u SE AGE POS *Number of Stories
0 Masonry(wall bearing) c pr rvat •Total square feet of floor area, ,,,ttt
Wood Frame ndiv' ual (septic tank,etc.) all floors,based on exterior //D
dimensions V
0 Structural steel
TYP OF TE SUPP •Total land area,sq.ft.
0 Reinforced concrete 0 blic priv corn Y
p Other—Specify NUMBER OF OFF-STREET
Ind -du (well, ' tern PARKING SPACES
Enclosed -
- PRINCIPAL TYPE OF HEATING FU TYPE OF FIREPLACE Outdoors
❑Gas
❑Oil RESIDENTIAL BUILDINGS ONLY
Number of bedrooms
❑Electricity TYPE OF MECHANICAL
• {Full
❑Coal Number of
ther—Specify bathrooms Partial Plij
IV. IDENTIFICATION- -
Mailing Address—Number,street,city and State ZIP code Tel.No.
t. �(�Na'�mye/.��y / y-�''y'� �j,' _ ley///��' '�'��� j//�Q��/'�v (�/'yy/�
//r�Jr I/C77r�.C!�I' /� �.JV`' '�+��_�- `^ /1d F'i t.� ` / U ��
Owner (5,,--„66,-Li„,---
2 Stare License No
Contractor
3. .
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
signature of applicant 1
Address : ApplicatiOn
ddress Application date
e PLANNING AREA _.:. DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY
Io
C JEFFERSON C= HE,&L-- DE- . I -- �'�,',
Cl _ PERMIT FEE y ISSU DATE PERMIT NUMBER
- I APPROVED BY: G
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F BOIL►I OFFICIA .
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