HomeMy WebLinkAboutBLD1981-00025I.
qs DE
BUILDING PERMIT APPLICATION
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 INTERSECT! OF . ROAD AND ROAD
other specific location or landmark: r I 'O f tot , , • 0,-)op
LEGAL DESCRIPTION: --al---- 3 . Ire gets 4 ,, r +6*-i
Lot Block _._ Sub in W
—
Tax Number Y4 Section Sectio Township Range
II.TYPE AND COST OF BUILDING
TYPE OF IMPROVEMENT. BUILDING TYPE MOBILITY
' New 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
)4(Mobile Island Facilities?
ED Wrecking I XI Mobile Home
❑Moving(relocation) ❑Other—Specify ❑YES ❑NO
❑Foundation only
USE
O RSHIP A 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 (� Ac, 1/',
c. Heating,air conditioning `'1`-�
d. Other (elevator,etc►
• TOTAL COST OF IMPROVEMENT (i,v
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS I
•Number of Stories
❑Masonry (wall bearing) ❑Public or Private
�� ✓✓ •Total square feet of floor area,
❑Wood Frame I�individual (septic tank,etc.) all floors,based on exterior
Structural steel J� _ dimensions I 344
❑Reinforced concrete TYPE OF WATER SUPPLY •Total land area,sq.ft. a
E]Public or private company 7-1/�
❑Other—Specify NUMBER OF OFF-STREET
Individual (well,cistern) PARKING SPACES
/\ Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY
Electricity Number of bedrooms
CD TYPE OF MECHANICAL
Number of Full
❑Other—Specify bathrooms
Partial
IV. IDENTIFICATION-
Name Mailing Address—Number,street,city and State ZIP code Tel.No.
1. 1 brn Ida ? . X Imo_. 7q
Owner 1
2. rff rA t ►/IE :E• . ,
Contractor r rate License No. la ff I ri!/_111.1:
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
gnature t ofof applicant Address ‘:;;t_P date
a ,[�
,`T, PLANNING AREA�FIRE DISTRICT SCHOOL DISTRICT (1v WATER DISTRICT
3 APPROVED BY Uc ` c
p JEFFERSON COUNTY HEALTH DEPT
d
I APPROVED BY: �_�� PERMIT FEE ISSUE DATE PERMIT NUMBER
W
e
a of a' BU DING OFFICIAL c:90 W (9- ( 8 ( ((/ (
- 97 .4.,,W2/ArecR
Oxford l'4ndaf[ex
STOCK NO. 43501/3
• •
MADE IN U.S.A.