HomeMy WebLinkAboutBLD1984-00008 THIS BUILDING IS
NOT FINALED .
PERMIT WAS CANCELLED
PRIOR TO RECEIVING ALL
INSPECTIONS AND HAS NOT
BEEN ISSUED A CERTIFICATE
OF OCCUPANCY.
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RECE►
,. JEFFERSON COUNTY
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BUILDING PERMIT APPLICATION
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 AA /
S W FROM INTERSECTION OF��} ROADAND44 Sc )a.t L ROAD
other specific location or landmark: t-LOe rt Pk■J >C'.'Obt t 1. s 1441/
LEGAL DESCRIPTION: % o�tti-4 ,_
Lot Block Subdivision r„�
c� ai X033 - J 5 3OA1 Gam,
Tax Number 'h Section Section Township Range
II.TYPE AND COST OF BUILDING
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
❑New building ingle Family ❑New County Resident
VAddition Multi-Family Is this structure to serve the residential
❑Alteration number of units or commercial needs of those employed
❑ Repair,replacement El Hotel,Motel,Dormitory at either the U.S.Navy's Trident or
number of units Indian Island Facilities?
El Wrecking
❑Mobile Home
❑Moving(relocation)
❑Other—Specify ❑YES- .INO
❑Foundation only
OWNERSHIP USE
Vdcgl Private (individual,corporation, Full-time Residence
nonprofit institution,etc.)
ID Public 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 a�b
$ I Q Q 0 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 1.."
c. Heating,air conditioning / is // Z q e `x D� c; ! r,`O
d. Other (elevator,etc I /V gk /!) X /6 /6 o x / 2, Z 4412.
• TOTAL COST OF IMPROVEMENT $ f
III.SELECTED CHARACTERISTICS OF BUILDING - 74)74/. • fog 6 0
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
❑Masonry (wall bearing) ❑P lic or Private •Number of Stories
( VOod Frame •Total square feet of floor area,
Individual (septic tank,etc.) all floors,based on exterior
El Structural steel _ dimensions 4(4 C3
❑Reinforced concrete TYPE OF WATER SUPPLY •Total land area,sq.ft. `T
❑Other—Specify ❑Public or private company
dividual (well,cistern) NUMBER OF OFF-STREET
PARKING SPACES
PRINCIPAL TYPE OF HEATING FUEL Enclosed
TYPE OF FIREPLACE
❑Gas Outdoors
ElOil RESIDENTIAL BUILDINGS ONLY
❑Electricity Number of bedrooms
❑Coal TYPE OF MECHANICAL
❑Other—Specify '0 J2 Number of {Full
bathrooms
Partial
IV. IDENTIFICATION -
Name Mailing Address— Number,street,city and State ZIP code Tel. No.
1. Ckatlt.s 5f,...4(.,. 44- 3 c,lAuJari._ R358 365 37 3e,. :
Owner
2. Sets, 1
Contractor State License No.
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Signat4te Of applicant _ Address
f tel �— Application date
i fe o �lLi:�� ( O— 17 -' 83.
a 3 e PLANNING AREA FIRE DISTRICT /c ✓ SCHOOL DISTRICT WATER DISTRICT
3 APPROVED BY •
C JEFFERSON COU sNE LTH DEPT . / ��/sy..e-4x.. 6-2(...,...„- 67:0, 0 o ,..„---we I APPROVED BY: PERMIT FEE ISSUE DATE PERMIT NUMBER
53
t DING OFFICIAL
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