HomeMy WebLinkAboutBLD1985-00044 I. BUILDING, PERMIT APPLICATION
Jetterson County Buiidrng Department • County Courthouse • Port Townsend, Wash 98368 • 385 1310
N E
I. LOCATION: 9ru9raonrc name S W SIDE OF ROAD � FEET
5W FROM INTERSECTION OF ROAD AND "`44.-1.(4, �sCJIC1 , PROAD
VT-1
other specific location or landmark 141-19'3'4 �� ���` 1: _
LEGAL DESCRIPTION:
Lot Block
Subdivision
e72 O/7) ■ te--'
Tax Number Y.Section Section Township Range
II.TYPE AND COST OF BUILDING
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
Q New building VISingle Family 0 New County Resident
Q Addition Q Multi-Family Is this structure to serve the residential
number of units, or•commercial needs of those employed
0 Alteration
Q Hotel,Motel, Dormitory at either the US.Navy's Tndent or
ql Repair,replacement number of units Indian Island Facilities?
Q Wrecking Q Mobile Home
Q Moving(relocation) Q Other—Specify Q YES ONO
Q Foundation only •
e'ail C' -1 t9")
USE
OWNERSHIP Q Full-time Residence
0 Private (individual,corporation, _ Q Second Home: Recreation Cabin,etc.
nonprofit institution,etc-)
Q Public (Federal,State or local gov't-) UBC OCCUPANCY GROUP: Q 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 nor 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 prposed use.
b. Plumbing K(3 v J
c. Heating,air conditioning 1
d. Other (elevator,etc.( _
en
• TOTAL COST OF IMPROVEMENT S 2 c>a�
III.SELECTED CHARACTERISTICS OF BUILDING -
DIMENSIONS
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL •Number of Stories
Q •
Masonry (wall bearing) Q Public or Privat •Total square feet of floor area,
Wood Frame El Individual septic tank -to.) all floors,based on exterior
dimensions
Q Structural steel
TYPE OF WATER SUPPLY •Tot- area,Q Reinforced concrete
Q Public or private company
Q Other—Specify NUMBER OF OFF-STREET
g[Individua 40,cistern) PARKING SPACES
Enclosed _ ,
• PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
Outd•••
Q Gas
QOil RESIDENTIAL BUILDINGS ONLY
Number of bedrooms
Q Electricity
• TYPE OF MECHANICAL
Q Coal till
Number of
NI tither—Specify bat hroo
Partial
IV. IDENTIFICATION-
Name // Mailing Address—Number,street,city and State ZIP code Tel.No.
'�� �/g`! �"cf 'o�%7r� ,�
Owner ` �/i - nsL� 9 "„ • - .__�-_
/:
ContractorccF 3a5
�- Z`43Pi
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Signature of . .•htant Address - 4./elizo jcs—,7ry /�,/)/4c�f � Application
\(s\
disr._`. -.der - _ date
d PLA ARE• DISTRICT CX SCHOOL DISTRICT WATER DISTRICT
r� IRE D I S
`3 APPROVED BY - /
o
G JEFFER N OIJN'TY ME*r.- 9.4 • PT..
d
- I APPROVE B PERMIT FEE ISSUE DATE PERMIT NUMBER
e ' 32 J� // �-.'� -J5-'
,,,25,•? ? -•
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