HomeMy WebLinkAboutBLD1980-00027 .
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BUILDING PERMIT APPLICATION
Jefferson County Building Department• County Courthouse •Port Townsend, Wash.98368 • 385-1310
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I. LOCATION: geographic name SW SIDE OF , Ina 3h:1) ROAD FEET
NE
S W FROM INTERSECTION OF ROAD AND ROAD
other specific location or landmark:
LEGAL DESCRIPTION: Sa r)► 0 S k a o q- PO 1 ✓1 ~f'
Lot Block Subdivision
Tax Number Y.Section Section Township Range
II.TYPE AND COST OF BUILDING 51.a1e_ skit 161 ', A Pliti 6.3e .a,L.r"y"'
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
IJ�New building 13Single Family Ig New County Resident
CI Addition ❑Multi-Family Is this structure to serve the residential
number of units
❑Alteration or commercial needs of those employed
❑Hotel,Motel,Dormitory at either the U.S.Navy's Trident or
El Repair,replacement number of units Indian Island Facilities?
El Wrecking ❑Mobile Home �,t
❑Moving(relocation) CD Other—Specify ❑YES' N NO
❑Foundation only
USE
OWNERSHIP L Full-time Residence --____
Private(individual,corporation,
nonprofit institution,etc.) ❑Second Home: Recreation Cabin,etc.
CI Public(Federal,State or local gov't.) UBC OCCUPANCY GROUP: f 3 El Second Home: Future conversion to
permanent residence
v 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
1 in the above cost department store,rental office building,office building at industrial plant.
a. Electrical If use of existing building is being changed,enterr proposed use
b. Plumbing main T `o01� ' aJSiO �`e G..*
c. Heating,air conditioning be.ie.nu../1 - - ,o,56 S c
v d. Other (elevator,etc.) GjQ/�LIQt. �{D S� P 1�
• TOTAL COST OF IMPROVEMENT $ t;Z Q(ate 1 {'�/ G/ c•-III.SELECTED CHARACTERISTICS OF BUILDING - v /
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL
DIMENSIONS
❑Masonry (wall bearing) •Number of Stories
Nt.
g ❑Public or Private •Total square feet of floor area,
Wood Frame ®Individual (septic tank,etc.) all floors,based on exterior p
c. ❑Structural steel dimensions
TYPE OF►NAT R SUPPLY •Total land area,sq.ft. 209
f\N= ❑Reinforced concrete Ncl♦ p,n
�Pubbb w or private company c'(� 'C
❑Other—Specify Individual (well,cistern) NUMBER OF OFF-STREET
❑ PARKING SPACES ^
Enclosed o[
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
.,,,, ,,44
❑Gas It�JSVatYS'2tfd�IQar4nGe
Outdoors . :u?
❑Oil bwnd �� � �j� RESIDENTIAL BUILDINGS ONLY
• ❑Electricity Number of bedrooms 3
CI Coal TYPE OF MECHANICAL
Full a
❑Other—Specify Nto-PI.lmp h tat P u Number of
P bathrooms
Partial '
IV. IDENTIFICATION
Name Mailing Address-Number,street,city and State ZIP code Tel.No.
1. DD114.s a,.d '11 I Dcx - 6;e. - Pr To,,inst r41.. WA 9R3b>' Itc-s3y9
Owner
1'4'I„t JhO use-
2. 'TIC k'a.,c S-r-2
Contractor State License No. I WA 3. ,D) . X1,11 If,r te...6 - 1,4-te 6'AP___— Pf 10an1¢.-e'd WA 9 ?VA' `s3v
Architect
&COA Inde/sPn 63V Cky — PI- T 4onSt.4 ti)A it 34 . 3gS-tl66
The owner of this building and the undersigned agree to conform to all applicable laws.
Signan of applicant j Address Application date
i PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
c APPROVED BY ("\<. Q • _ PI, __
P JEFFERSON COUNTY HEALTH DE`�..
.-
l APPROVED BY: PERMIT FEE ISS DATE PERMIT NUMBER
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STOCK No. 7531/3
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MACE IN U.,..0.