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HomeMy WebLinkAboutBLD1987-00046 ilk BUILDING PERMIT APPLICATION • Jefferson County Buildin&Wartment• County Courthouse •Port Towns4111 Wash.98368 • 385-1310 N E I. LOCATION: geographic name S W SIDE Of I q \rR�OAOD�, FEET N E • �O W , V ""�^^' S W FROM INTERSECTION OF ROAD AND 4 / ,�^^� �C ROAD other specific location or landmark: 0,A4 " " LEGAL DESCRIPTION: P Lot Block in S i4. o/hij FF �`(3O O©3 Y? Tax Number 'h Section Section/ Township Range II. TYPE AND COST OF BUILDING - TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY ❑New building ❑Single Family ❑New County Resident Addition ❑Multi-Family Is this structure to serve the residential number of units or commercial needs of those employed ❑Alteration ❑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) 00t r—Specif ❑YES ❑NO ❑Foundation only 1 USE OWNERSHIP ❑Full-time Residence ❑Private (individual,corporation, ❑Second Home: Recreation Cabin,etc. nonprofit institution,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 bui ing is being changed,enter proposed use. b. Plumbing . 64,-A''-1,_ Y0 xZ — /`' y ,0/" g c�� -74,80g2 c. Heating,air conditioning = _ �,4��? d. Other (elevator,etc) • TOTAL COST OF IMPROVEMENT $ III.SELECTED CHARACTERISTICS OF BUILDING - PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS •Number of Stories ❑Masonry (wall bearing) ❑Public or Private •Total square feet of floor area, Wood Frame ❑Individual (septic tank,etc.) all floors,based on exterior dimensions ❑Structural steel , TYPE OF WATER SUPPLY • ❑Reinforced concrete •Total land area,sq.ft. ❑Public or private company ❑Other—Specify Individual (well,cistern) NUMBER OF OFF-STREET ❑ PARKING SPACES Enclosed PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE Outdoors ❑Gas ❑Oil RESIDENTIAL BUILDINGS ONLY ❑Electricity Number of bedrooms 2 TYPE OF MECHANICAL - ❑Coal Number of Full ❑Other—Specify bathrooms Partial IV. IDENTIFICATION- Name Mailing Address—Number,street,city and State ZIP code Tel.No. I. • SaoI w41 8a 7 2—Lia3 Owner ,,",' Z State License No. Contractor 3. _ - Architect The owner of this building and the undersigned agree to conform to all applicable laws. of applicant Si afie Address Application date G� ,�' ���� " _ -63Cfr CC./ Cll rE' c F 1047 7 I PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT '. APPROVED BY 0V__ a--e`4-� c-' JEFFERSON C ` Tli EPARTWIEP(F '+� �I` 7 NUMBER APPROVED BY _-� PERMIT FEE ISSUE DATE RECEIPT' �y a(03 / 8 �g/ . i BUILDING OFFICIAL 100 , 5v 644 , The Printery —Port Townsend 70 H /Q 3 —1 g -4 ?- #4,pc-/LA-720r( A.717--- /14 A.2 ,-- A/ k.C1 Dct„ .-Icitk Ai. PROVEC rt 87 4A -77 2:> —4L1,st.et-rLe4, 00.0 o a La x¼L •cE-S CT'S 0-A 0"1- ,0 aiaqi F5'S" g4mLurcue___ 3 (s.t ‘C. e C/a