HomeMy WebLinkAboutBLD1976-00016 i
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JEFFERSON COUNTY COMMISSIONERS 1—Health Dept.
Port Townsend, Washington
BUILDING PERMIT APPLICATION
IMPORTANT - Complete ALL items. Mark boxes where applicable.
ber street Subdivision I Lot I Block Census tract
i. I
LOCATION> �" i I -`> -
OF VS `c}`_ "Y\ N S v"i U - 3)
BUILDING E W side of feet E W from intersection of
(Other local geographic, political, or legal subdivision identification)
II. TYPE AND COST OF BUILDING - All applicants complete Parts A - 0
A. TYPE OF IMPROVEMENT D. PROPOSED USE - For "Wrecking" most recent use
...1. New building Residential Nonresidential
221 !Addition(If residential, enter number 12 Li One famil y 18 Li Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13 wo or more family -Enter 19[ Church, other religious
umber of units------r
3I I Alteration (See 2 above) 20 n Industrial
14 L Transient hotel, motel,
4I I Repair, replacement or dormitory -Enter number 21 Parking garage
5 I I Wrecking(If multifamily residential, of units- -1. 22 Service station, repair garage
enter number of units in building in 15 Garage 23 Hospital, institutional
Part D, 13)
6 1-1 Moving (relocation) 16 LII Carport 24 Office, bank, professional
7 I Foundation only 17 � Other -Specify 25 Public utility
26 School, library, other educational
B. OWNERSHIP 27 Stores, mercantile
8 rivate (individual, corporation, 28 Tanks, towers
n nprofit institution, etc.) 29 Other -Specify
9I ] Public (Federal, State, or
local government)
C. COST (Omit cents) Nonresidential - Describe in detail proposed use of buildings, e.g., food
processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement S. school, secondary school, college, parochial school, parking garage for
To be installed but not included department store, rental office building, office building at industrial plant.
in the above cost If use of existing building is being changed, enter proposed use.
a. Electrical a — ‘-'
b. Plumbing
c. Heating, air conditioning
d. Other (elevator, etc.) _
11. TOTAL COST OF IMPROVEMENT $7 ,O FO ��..-
III.SELECTED CHARACTERISTICS OF BUILbING - For new buildings and additions, complete Parts E - L;
for wrecking, complete only Part J, for all others skip to IV.
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS /
30[ _1 Masonry (wall bearing) 40 Li Public or private company 48. Number of stories
81 ood frame 49, Total square feet of floor area,
41ividual (septic tank, etc.) all floors, based on exterior
2 L] Structural steel dimensions .''
331 I Reinforced concrete H. TYPE OF SUPPLY _
34 Li Other -Specify 42 ublic or private company 50. Total land area, sg.J.L. a� �t{,`j
43 I I Individual (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed
35I I Gas Will there be central air 52. Outdoors
conditioning?
361 I oil L. RESIDENTIAL BUILDINGS ONLY
3 �x7`,
lectricity 441 I Yes 45 53. Number of bedrooms (/
3Coal
39I I Other -Specify Will there be an elevator? Full
ii
461 1 Yes 47 54. Number of
bathrooms
Partial
IV. IDENTIFICATION - To be completed by all applicants
Name Mailin address -.Number, street, city, and State ZIP code Tel. No.
Owner ,-- �� ter/ . .., `
/ _� x'33 ,,2-,-.
2.
Contractor State License No. I
3.
Architect
The owner of this building and e u /,/gned agree to conform to all applicable laws of (name of permit jurisdiction).
S'_ atur_ of applicant ,� es Application date A
. 6 5-caa ..P- /7- ,
DO NOT WR E IN THIS SPACE - FOR OFFICE USE
Approv by Perm it f e Q Date permit issued Permit number
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