HomeMy WebLinkAboutBLD1992-00717 BUILDING PERM ITrAPPLICA1 '
Jefferson County Building Department• Count Courthouse •Port Townsend,Wash.98368 • 385-1310
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I. LOCATION: geographic name S W SIDE OF ROAD,_ � ° 1 FEET
S W FROM INTERSECTION OF ROAD AND' C L-"� ) '�l0 Juf� ROAD
other specific location or landmark: 6
�f ( .,
LEGAL DESCRIPTION: ._J
Fb—Ict
/j I --- ( F 0 Block . bdi ( c
,� „ Tax umber Y.Section Section Township - Range
II.TYPEL CIJO'OF BUILDING-
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
S✓✓✓
ew building ElSingle 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 ❑Mobile Home
❑Moving (relocation) Other—Specify ❑YES ❑NO
❑Foundation only ,r-j
e, ().
OWNERSHIP 7-6 Y I i USE
❑Full-time Residence
❑Private (individual,corporation, 1"�"''�'�
nonprofit institution,etc.) V o ( -I-- - / ❑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 'ng nged,A
nter proposed use.b. Plumbing 3 c( 6) /`mil C _C�QJ
c. Heating,air conditioning ` �}�� r�
d. Other (elevator,etc.) ( 0 � ) \
• TOTAL COST OF IMPROVEMENT $ 111 # /_�t�\VI( gj5--''
/
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
Ii
❑ asonry (wall bearing) •Number of Stories
❑Public or Private
,32
Wood Frame •Total square feet of floor area,
❑Individual (septic tank,etc.) all floors,based on exterior
❑Structural steel dimensions
TYPE OF-WATER SUPPLY
LI Reinforced concrete •Total land area,sq.ft.
❑Other—Specify ❑'Public or private company
NUMBER OF OFF-STREET
❑Individual (well,cistern) PARKING SPACES -
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE '
❑Gas Outdoors
❑Oil '' RESIDENTIAL BUILDINGS ONLY
❑Electricity;. Number of bedrooms
❑Coal TYPE OF,MECHANICAL
Nutr of Full
rr��bb
ther—Specify . .
�tfirooms
Partial
IV. IDENTIFICATION- . yr7D (id ( 0_,2 _ , ,i) 6-4-dz, PEP 7
Name Mailing Address—Nu .er,set,city and State ZIP code Tel.No.
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Architect
The owner of this b ' ring and the undersigned agree to conform to all applicable laws.
Arat,y,d7/7
ig ure of plic••�� Addres� �P ��,.� V`--
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PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY Ik\r`04,49"
JEFFERS° OUNTY HEAL DEPARTMENT
APPROVE P V _ PRMIT, ISSUE DATE 1 RECEIPT NUMBER
G-- 7 S-74:70,,N -
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