HomeMy WebLinkAboutBLD1980-00026 `3'-go3
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BUILDING PERMIT APPLICATION
i
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 ,.,cROAD AND 1 ROAD
other specific location or landmark:e.. `C Y�.'e Nr 0'-'c K `Z �■`IA 0\ '-' W w\ \■
LEGAL DESCRIPTION: 6.7 Diu, / 4:9_/ ,04//?
Lot Block Subdivision
Tax Number '/4 Section Section Township Range
II.TYPE AND COST OF BUILDING
TYPE OF IMPROVEMENT BUILDING TYPE rfigtlew building .Single Family ❑New County Resident ,
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
❑Repair,replacement number of units Indian Island Facilities?
❑Wrecking ❑Mobile Home
Moving(relocation) ❑Other—Specify ❑YES ❑NO
❑Foundation only
USE •
OWNERSHIP Residence
Q;6—Private(individual,corporation, ❑Second Home: Recreation Cabin,etc.
nonprofit institution,etc.)
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: `-3 ❑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 m'1CNi. VA" ) 14 C' I 2 Q,Q a
c. Heating,air conditioning 6- - 6 3 4, o o
d. Other(elevator,etc.) G a.'c-,
• TOTAL COST OF IMPROVEMENT $6 ,Sc )- 3 l 1 7/
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS t
•Number of Stories
❑Masonry (wall bearing) ❑Public or Private
•Total square feet of floor area,
ligi Wood Frame F: Individual (septic tank,etc.) all floors,based on exterior n L?
❑Structural steel dimensions �G 7
❑Reinforced concrete TYPE OF WATER SUPPLY wv‘.. •Total land area,sq.ft. I Sc)K I 07
-'Public or private company
❑Other—Specify NUMBER OF OFF-STREET
❑Individual (well,cistern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
Outdoors
❑Gas F'.'c-e_R\e4._c2.
❑Oil RESIDENTIAL BUILDINGS ONLY
®.ElectricityC C�e. \v- Number of bedrooms
❑Coal TYPE OF MECHANICAL n
Number of Full ..G__
' I ,Other—Specify bathrooms
Partial
IV. IDENTIFICATION-
Name Mailing Address—Number,street,city and State ZIP code Tel.No.
1. e2'c�
Owner KNI.■,;,-r\■
2. �oL.13 e. 0.-z .3 ILI Ll- L08.3
Contractor State License No. L
t' -`rXS� ARTSN *2- 3K S' ' L\ 9g3' 30l f
3.
Architect
Th- • ner of this building and the undersigned agree to conform to all applicable laws.
gnatur. of applicant Address Application date
a �j
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L y PLANNING AREA i FIRE DISTRICT 4 SCHOOL DISTRICT WATER DISTRICT
k APPROVED BYO K )t'c- ' d Li-4 -
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p JEFFERSON COUNTY HEALTH DEPT , \' � ' \\_ lc■
I APPROVED BY: PERMIT FEE ISSUE DATE PERMIT NUMBER
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