HomeMy WebLinkAboutBLD1979-00023 - BUILDING PERMIT APPLICATION 7137
Jefferson County Building Department• County Courthouse •Port Townsend, Wash.98368 • 385-1310
N E
I. LOCATION: geographic name S W SIDE OF ROAD FEET
NE
S W FROM INTERSECTION OF `` ROAD AND ROAD
other specific location or landmark: .rO Y ■6'8\8, 7 cA4,-.. \C Y1 1 & I.'' E__.
LEGAL DESCRIPTION: 28 -af v-18-,20
•
Lot Block .
5 3y 3c j RtL -
Tax Number %Section Section Township Range
II.TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
y'd New building Allingle 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
number of units Indian Island Facilities?
❑Wrecking
❑Mobile Home
❑Moving (relocation)
❑Foundation only ❑Other-Specify ❑YES ❑NO
OWNERSHIP USE
1-]Private (individual,corporation, ull-time Residence
nonprofit institution,etc.) ❑Second Home: Recreation Cabin,etc.
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: R``-3 ❑Second Home: Future conversion to
COST
permanent residence
(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\n _ /37(3-- -9 O
c. Heating,air conditioning Lo. ..-1- `f�5- ' . 7 `
d. Other (elevator,etc.) '7 7
• TOTAL COST OF IMPROVEMENT $30 LX 3
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
❑ •Number of Stories Y.2_.Masonry (wall bearing)
❑Public or Private
Wood Frame
•Total square feet of floor area,
Individual septic tank,etc.) all floors,based on exterior
E Structural steel 'rrs s dimensions
❑ Reinforced concrete TYPE OF WATER SUPPLY
C t-ft/ •Total land area,sq.ft. Ll f' -f-
❑Other-Specify Public or private company [ 3
❑Individual (well,cistern) NUMBER OF OFF-STREET
PARKING SPACES
PRINCIPAL TYPE OF HEATING FUEL Enclosed
TYPE OF FIREPLACE
LI Gas Outdoors
❑Oil 1 \ < \ U RESIDENTIAL BUILDINGS ONLY
1 Electricity —� ^�c�, Jam- Number of bedrooms
❑Coal \ TYPE OF MECHANICAL
K Other-Specify LJl>(�C�) Number of Full
bathrooms
Partial I
IV. IDENTIFICATION -
Name Mailing Address- Number,street,city and State ZIP code Tel.No.
,. EAf)a{Y--c�. P.r). \6n hk-)() (�['�figp 3 8S-
Owner I u� 1 a-t-t Ca Et -a c.., 1 i .0a ! 1337 ! 4/0 7?
2. �� t r
Contractor 3e\ State License No.
3.
Architect
The owner of this biI ing and the undersigned agree to conform to all applicable laws.
Sign f applic n Address Application date
• i, 724 se l0 e e.4- ?- --79 x
PLANNINCIAREA - - FIRE DISTRICT SCHOOL DISTRICT i i WATER DISTRICT
APPROVED BY
OLYMPIC HEALTH DISTRICT: '�
APPROVED BY: PE' FEE ' ISSUE DATE PERMIT NUMBER
1; Z2) Cho 4
I ING OFFICIAL `' -� r- I r
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