HomeMy WebLinkAboutBLD1976-00018 BUILDING PERMIT APPLICATION ,a 9
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
NE
S W FROM INTERSECTION OF
ROAD AND
ROAD
/ �other specific location orlandmark: e,% _
/ I /
LEGAL DESCRIPTION: )°1'1 G �0 p C^
Lot Bleu l Subdivision
Tax Number 'h Section Section Township Range
II. TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
�<eOFw building ❑Single Family ❑New County Resident
❑Addition Multi-Family +t _ Is this structure to serve the residential
• number of units cam`
El 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 ❑YES ❑NO
❑Foundation only
E
$ SHlPrivate (individual,corporation, Full-time Residence
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 r!���/C.L_e "sift ..�
c. Heating,air conditioning
d. Other (elevator,etc.)
• TOTAL COST OF IMPROVEMENT $a6 7, 20.
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS /
❑Masonry (wall bearing) •Number of Stories
,,��....// Y 9 ❑Public or Private •Total square feet of floor area,
Frame rvidual (septic tank,etc.) all floors,based on exterior 1(�''�(i�
❑❑`Structural steel dimensions 1 VCJ
El Reinforced concrete TYPE OF TER SUPPLY •Total land area,sq.ft.
Public or private company
❑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 14
lectricity ��^��^�!!��'' Number of bedrooms
❑Coal TYPE OF MECHANICAL cT
Number of Full
❑Other—Specify bathrooms
Partial
IV. IDENTIFICATION -
Mailing Address— Number,street,city and State ZIP code Tel. No.
1.
J;;;_", C /f�cr/ . aj 3 3
Owner
2. &=7771-A6" `� � R
Contractor �/. / 5 ate Licen/2No. l I
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Si- re J,appli� t. / j ess Application date
f '
PLANNING AREA q— FIRE DISTRICT / SCHOOL DISTRICT' T WATER DISTRICT
APPROVED BY a r \'01- _ a _ 76
OLYMPIC HEALTH DISTRICT:
App�yEsp62 i PERMIT FEE ISSUE DATE PERMIT NUMBER it
BUILDING OFFICIAL / ‘ '
1
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