HomeMy WebLinkAboutBLD1977-00015 BUILDING PERMIT APPLICATION ,� 77,2--
Jefferson County Building Department• County Courthouse • Port Townsend, Wash.98368 • 385-1310 �`�
N E
I. LOCATION: geographic name S W SIDE OF _. ROAD FEET
N E /�
S W FROM INTERSEC ON OF 'OPrB(111r1a L_�i ROAD
other specific location or landmark: ' t f - _p,,�1 /�
LEGAL DESCRIPTION: e'�j /� /�/�'ti"e k /T"
Lot Block Sub•ivision
Tax Number Y.Section Section Township Range
II.TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBBIILIITTY
•
ew building IXI SlMingle Family L 'lvew County Resident
❑Addition El Multi-Family Is th 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 ONO
❑ Foundation only
•
U
OV7SHIP Full-time Residence
Private (individual,corporation,
onprofit institution,etc.) ❑ econd 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 r■ I V 6 0 7 ao o
c. Heating,air conditioning (� j/i. — � JV 6 0 n
d. Other (elevator,etc.) a J _ .-J (J? T, Frn o
• TOTAL COST OF IMPROVEMENT $
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS I
❑Masonry (wall bearing) El Public or Private •Number of Stories
`,.. ���,,,���,,,���•••
•Total square feet of floor area,
l t�vood Frame Individual (septic tank,etc.) all floors,based on exterior
/� l (Q
❑Structural steel dimensions
❑Reinforced concrete TYPE OF WATER SUPPLY •Total land area,sq.ft. ,!
❑Pu is or private company i O h / 0
❑Other-Specify NUMBER OF OFF-STREET
❑I di dal ( ell,cistern) PARKING SPACES
' Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY
lectricity Number of bedrooms
❑Coal TYPE OF CHANICAL
Number of Full
❑Other-Specify bathrooms
Partial
IV. IDENTIFICATION -
Name Mailing Address-Number,street,city and State ZIP code Tel.No.
1. -
Owner 1 Jl..l — ^ n C)-)
Contractor Stat Lice No. t
3. . -)6- 75-.2 -. ..2o 4)
Architect u �] (�
, _ _ n 1
The owner of this b ' ing and the un•- ...ned agree to conform to all applicable laws. / rJ(�f' J/
46 re oa pplica //� Address Application date
7
PLANNING AREA o2 FIRE DISTRICT 6, SCHOOL DISTRICT 50 WATER DISTRICT
APPROVED BY /'� � l ��1 OLYMPIC HEALTH DISTRICT: 0-1(• \ - 2.
' APPROV • BY: PERMIT FEE ISSUE DATE PE$MIT NUMBER
9, 1 35 1- / .a2. % -14475 .
:UILDING OFFICIAL • ■ X/ 3/77
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