HomeMy WebLinkAboutBLD1977-00014 BUILDING PERMIT APPLICATION )��
Jefferson County Building Department• County Courthouse •Port Townsend, Wash.98368 • 385-1310
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I. LOCATION: geographic name S W SIDE OF ROAD FEET
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S W FROM INTERSEC-T(O OF / ROAD AND ROAD
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other specific location or landma /:'/ ... — O f �rd� L�
LEGAL DESCRIPTION: .Z.,/". -
Lot Block Subdivision
Tax Number 1/4 Section Section Township Range
II.TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
w building ingle Family ❑New County Resident
❑Addition ❑Multi-Family Is this structure to serve the residential
number of units
❑Alteration or commercial needs of those employed
El Repair,replacement ❑Hotel,Motel, Dormitory at either the U.S.Navy's Trident or
number of units Indian Island Facilities?
❑Wrecking ❑Mobile Home
❑Moving (relocation) ❑Other—Specify
CI YES ONO
❑Foundation only
USE
OWNERSHIP
Full-time Residence
rivate (individual,corporation,
nprofit 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 36 68-O
c. Heating,air conditioning ` y 40
d. Other (elevator,etc I .___ 7 9 R v
• TOTAL COST OF IMPROVEMENT $
III.SELECTED CHARACTERISTICS OF BUILDING -
DIMENSIONS
PRINCIPAL TYPE OF FRAME T PE OF SEWAGE.QISPOSAL I
El Masonry (wall bearing) ublic or Private •Number of Stories
•Total square feet of floor area,
7bodFrame ❑In ividual(septic tank,etc.) all floors,based on exterior O
Structural steel dimensions
❑Reinforced concrete TYPE,OF lNA F.(3 S�IPPLY •Total land area,sq.ft. (
''❑Public or private co y X / 6.
�4
❑Other—Specify NUMBER OF OFF-STREET
III In. .l well,cistern►. ). PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE A'
❑Gas Outdoors
❑Oil � a� RESIDENTIAL BUILDINGS ONLY
DElectricity Number of bedrooms S
al TYPE OF MECHANICAL
Number of Full .1.02.
❑Other—Specify bathrooms
Partial lt
IV. IDENTIFICATION -
ame Mailing Address— mber,street,city and State ZIP code Tel.No.
1. s —i • / - it ./ gi�-���
Owner -/1����/c%J
' � -4:3-1.
2.
Contractor /� Sta. icense No.
3. f / -//X i -e---la---- - &tr
Architect
/ 34/ 7 7
The owner of this building and the undersigned agree to conform to all applicable laws.
Signat, ppl' nt Address Application date
PLANNING AREA 7 FIRE DISTRICT SCHOOL DISTRICT -4, WATER DISTRICT
APPROVED BY
OLYMPIC HEALTH DISTRICT:
APPROVED BY: PERMIT FEE ISSUE DATE PERMIT NUMBER
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The Printery—Port Townsend
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