HomeMy WebLinkAboutBLD1982-00018 •i
BUILDING PERMIT APPLICATION
Jefferson County Building Department•• County Courthouse ••Port Townsend, Wash.98368 •• 385-1310
N J / /� �1
I. LOCATION: geographic name >'- (� ,1 P'1 •IIG.�. ROAD FEET
NE 44PP
S W FROM INTERSECTION OF ROAD AND ROAD
II� /t / / e
other specific location or landmark: T u rIA S. Ob1 a . &424 W/ D ct ji'1 /--k�-i- S 4-S S l�aI I I
LEGAL DESCRIPTION: I _ ✓
Lot Block Subdivision
3 .a / lyt/v�r
�` �- PTN I/TX _ s t
Tax Number Ifs Section Section Township Range
II.TYPE AND COST OF BUILDING
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
LNew building ❑Single Family ❑New County Resident
❑Addition ❑Multi-Family Is this 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 TAMobile Home
❑Moving(relocation) ❑Other-Specify �,/
❑YES C.)(10
❑Foundation only
USE
OWNERSHIP
Full-time Residence
Private (individual,corporation,
nonprofit 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
•
c. Heating,air conditioning
d. Other (elevator,etc 1
• TOTAL COST OF IMPROVEMENT S
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
❑Masonry (wall bearing) ❑Public or Private •Number of Stories I
•Total square feet of floor area,
)(Structural Frame 'Individual (septic tank,etc.) all floors,based on exterior
y�LStructural steel dimensions al 3,sr P,
/DR- TYPE OF WATER SUPPLY •Total land area,sq.ft p� Q if
❑Reinforced concrete O Z, T`
❑Other-Specify ❑Public or private company
NUMBER OF STREET
• n dividual (well,cistern) .
PARKING SPACE S
U.;i\ aQ tr�- q.t IN
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY
Electricity Number of bedrooms
❑Coal TYPE OF MECHANICAL
Number of Full /
❑Other-Specify '
bathrooms
Partial j�
IV. IDENTIFICATION-
Name Mailing Address 7- J
-Number,street,city and State ZIP code Tel.No.
Owner L E- [F1 t„,(1/9' f I /r7 5c...<.!( (CIL 'Q fO ?2fo
2. `J
Contracto State License No.
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Signs re of applicant _ Addre s Application date
�e,�� , 2t 7!1 .8gR- 9gJ7C
m PLANNING AREA SO FIRE DISTRICT SCHOOL DISTRICT k'' 5( WATER DISTRICT
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c APPROVE BY b 9-64 Z �) ��
O� d ' ° 'WC Ph oI� D°�y� .7 �vrv� 74,/x-L
ij JEFFERSON CO ° LTH DEPT 00
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I APPROVED BY: PERMIT FEE ISSUE DATE PERMIT NUMBER
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