HomeMy WebLinkAboutBLD1979-00024 BUILDING PERMIT APPLICATION 7€ 1 a
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
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other specific location or landmark: �' a ��t��C_____ .)--
LEGAL DESCRIPTION: y 1� 2..2
Lot Block
A ' Subdivision
Tax Number '4 Section Section Township Range
II. TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
New building bgt.Single Family ❑New County Resident
❑Addition ❑Multi-Family Is this structure to serve the residential
❑Alteration number of units or commercial needs of those employed
Repair,replacement ❑Hotel,Motel, Dormitory at either the U.S.Navy's Trident or
❑ pa P number of units Indian Island Facilities?
❑Wrecking ❑Mobile Home
❑Moving (relocation) ❑Other—Specify ❑YES ONO
❑Foundation only
USE
OWNERSHIP Full-time Residence
+nonprofit institution,etc.)
(individual,corporation,
❑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.
a
b. Plumbing .i -l-\ a.°0(.a.°0(. 4 Gr_.,
c. Heating,air conditioning 9 q. 200
d. Other (elevator,etc I G. ,, .SO CD
• TOTAL COST OF IMPROVEMENT $ /:?�fCZ2`�
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS 7--
❑Masonry (wall bearing) El Public or Private •Number of Stories
•Total square feet of floor area,
Wood Frame IndividuaL(septic tank,etc.) all floors,based on exterior
❑Structural steel e)li S II dimensions
TYPE OF WATER SUPPLY •Total land area,sq ft
❑Reinforced concrete I �� �
❑Other—Specify Public or private company NUMBER OF OFF-STREET
❑Individual (well,cistern) PARKING SPACES
;.s-\----
ex ' ` Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
Outdoors
❑Gas \P C)
❑Oil pc-e_ " t RESIDENTIAL BUILDINGS ONLY
MElectricity Number of bedrooms y
❑Coal TYPE OF MECHANICAL
Number of
Full 5
❑Other—Specify bathrooms
Partial
IV. IDENTIFICATION -
Name L Mailing Address— Number,street,city and State ZIP code Tel.No.
f. Ri I I tca12 V8\X
Owner L' `Cf\2x■
2. G-o<< --V 7/I 1(7.3- Q 4. ,S : 778
Contractor �+ State License No. _ I \\ gQ J,�j ^�
l T �1AC:,\f6 X25 -tii-a-CS°Ee33f/.1 �'c -?b` \\ S / 60 'iP;aq
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Signature of applicant Address Application date
PLANNING AREA -2 FIRE DISTRICT 6 SCHOOL DISTRICT i-5-0 WATER DISTRICT
APPROVED BY
OLYMPIC HEALTH DISTRICT: -----Th ftliii--._
APPROVED BY: PERMI FEE ISSUE DATE PERMIT NUMBER
BUILDING OFFICIAL
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-,, The Printery—Po�ssend Cps 00C-I.D3v
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