HomeMy WebLinkAboutBLD1976-00017 BUILDING PERMIT APPLICATION l/
Jefferson County Building Department• County Courthouse •Port Townsend, Wash.98368 • 385-1310
N E
I. LOCATION: geographic name SW SIDE OF ROAD FEET
NE
S W FROM INTERSECTION OF ROAD AND ROAD
other specific location or landmark: 1�iifl-C° ---,
0
LEGAL DESCRIPTION: /_2—/6 .�Or »L-V
Lot Block Subdivision
Tax Number Y.Section Section Township Range
II. TYPE AND COST OF BUILDING-
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
..;4ew building ❑Single Family El New County Resident
❑Addition _1ulti-Family c� Is this structure to serve the residential
❑Alteration number of units 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 Cl YES ❑NO
❑Foundation only
USE
OWNERSHIP )ull-time Residence
rivate (individual,corporation,
n nprofit institution,etc.) El 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 a - kik l--- CL,L
c. Heating,air conditioning
d. Other (elevator,etc I
• TOTAL COST OF IMPROVEMENT $,:3 /ta
III.SELECTED CHARACTERISTICS OF BUILDING -
DIMENSIONS
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL •Number of Stories
El Masonry (wall bearing) ❑Public or Private
1�,` r
•Total square feet of floor area,
Wbod Frame Individual (septic tank,etc.) all floors,based on exterior I b
dimensions b
❑Structural steel
❑Reinforced concrete TYPE OF WATER SUPPLY •Total land area,sq.ft
lic or private company
❑Other-Specify - NUMBER OF OFF-STREET
❑Individual (well,cistern) PARKING SPACES
Enclosed AT
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE J
El Gas Outdoors
�❑OOilJ RESIDENTIAL BUILDINGS ONLY
yiectricity i)...11-^^^- ' Number of bedrooms `�-
/❑Coal
TYPE OF MECHANICAL
Number of Full
❑Other-Specify bathrooms
Partial
IV. IDENTIFICATION -
N e //�� Mailing Address- Number,street,city and State ZIP code Tel.No.
1. .r,/,7 C../�
Owner
2. _...1 ■ 4J,i � . I Cl?339
Contractor Mate icense No.
3.
Architect
The owner of this building and e undersigned agree to conform to all applicable laws.
Si.e p.li . 4 )/ Address Application date
;' ���� f, Q 90 .5- �o ,& lug /� tea- 7 d "
FANNING AREA FIRE DISTRICT / SCHOOL DISTRICT !� WATER DISTRICT
APPROVED BY 4 pt14 / 1 .z_ Y,p . ,: .;7. `7 A Kon' Ljtj�-.
OLYMPIC HEALTH DISTRICT:
APPROVED BY: PERMIT FEE ISSUE DATE PERMIT NUMBER
,�� ' '�7 /76 I `/ I
/UILDING OFFICIAL /
The Printery -Port Townsend
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; �, ii7 C e Adrri 5 ' 1i- -�7
MO TT/557 P J.
903 E. Caroline OLYMPIC HEALTH DISTRICT Permit No. . /.791
Port Angeles, Wash. SEWAGE DISPOSAL PERMIT APPLICATION
Submit in Duplicate Builder CS -\:‘,..< J
Courthouse Q.% , oc \SS�`t
Port Townsend, Wash. Q.� \ ��7< ab0p�` r_ Date .�'. 7–p7
oWN 1 l Q= ����S`J H ss,PO Rc, k .moo' .S At4q 4 4.- PHONE`�fl s5 ,-f7->----
DIRECTIONS FOR LOCATING SITE
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APPLICATION IS HEREBY MADE TO: INSTALL NEW SYSTEM REPAIR EXISTING SYSTEM
p4.1).4 l7 K .5 $ - bn^ S .rid L—f-/-)0 .5/r I/S.
TYPE OF BUILDING NO. OF BEDROOMS BASEMENT S E SIZE NAME OF INSTALLER
/S c.
DRAINFIELD LENGTH I QC) WIDTH,;`1'3° DEPTH 3c; #LINES 3- SE1 C TANK SIZE a•1A�ti'S �s
DRAW A DETAILED PLOT PLAN BELOW. SEE INSTRUCTIONS. SOIL TYPE (_441)/27L A S S�o^��'
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ANY CHANGE IN BUILDING OR SEWAGE DISPOSAL PLANS, LOCATION OR SITE, INVALIDATES THIS
PERMIT UNLESS PRIOR APPROVAL OBTAINED FROM THE HEALTH DEPARTMENT.
E OF INSTALLATION SIGNATURE OF APPLI
A ROV f ED DATE 3 /I /74 INSPECTED BY .t .. __ -\\,-;:,....... DATEY -2/ 7t,
SANITARIAN'S COMMENTS: - ��'~
�, -� � \i-5 S\��\ �Z i�\�\.�4\4 ���� V\�
24 7/77 - G'CIA-L G v� Fv��' �S.t ri0 CAI 6,,./ c,'iv, .A._I CERTIFY THAT THISjSYSTEM9A�INSTAL,LED�fI THE MANNER APPROVED BY THE HEALTH
DEPARTMENT �.'l ti DATE
INSTALLERS NAME
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