HomeMy WebLinkAboutBLD1981-00060 BUILDING PERMIT APPLICATION 0, ct 1 ,.5/
Jefferson County Building Department• County Courthouse • Port Townsend, Wash.98368 • 385-1310
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I. LOCATION: geographic name S W SIDE OF ROAD FEET
NE
S W FROM INTERSECTION OF ROAD AND / ROAD
other specific location or landmark: V . • I • a a w. w o yc/6/O/ /C?Ge`�n e$-Rd
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LEGAL DESCRIPTION:
Lot � Block Subdivision
\
'7 . qN I (A)
Tax Number %a Section Section Township Range
II.TYPE AND COST OF BUILDING
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
14'New building Single Family Cl New County Resident
❑Addition ❑Multi-Family Is this structure to serve the residential
number of units
❑Alteration or commercial needs of those employed
❑Repair,replacement ElHotel,Motel, Dormitory at either the U.S.Navy's Trident or
number of units Indian Island Facilities?
❑Wrecking
El Mobile Home
❑Moving (relocation) ❑Other—Specify ❑YES ONO
El Foundation only
USE
OERSHIP Full-time Residence
Private (individual,corporation,
nonprofit institution,etc.) ❑Second Home: Recreation Cabin,etc.
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: R-O ❑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 n "..rr�iaiiir7�YGi110Wi CI On /�J r)
c. Heating,air conditioningaa_UrX
d. Other (elevator,etc.) J .
• TOTAL COST OF IMPROVEMENT $ t,Q ) lJ
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III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
❑Masonry (wall bearing) •Number of Storiesall
❑Public or Private •Total s are feet of floor area,
Wood Frame 9!�
Individual (septic tank,etc.) dimensiofloorS,based on exterior IL�I l /
Structural steel dimensions
❑
TYPE OF WATER SUPPLY
❑Reinforced concrete •Total land area,sq.ft
❑Public or private company 3
❑Other—Specify NUMBER OF OFF-STREET
Individual (well,cistern) PARKING SPACES I
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
Ell Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY
El Electricity Number of bedrooms
❑Coal TYPE OF MECHANICAL
Number of Full
Other--/S Specify bathrooms
50 r Partial
IV. IDENTIFICATION-
Name Mailing Address—Number,street,city and State ZIP code Tel.No.
1. ie Rt � v .c 7 -=
Owner bro S
Thrt-
2. Gr Yed CSS
Contractor License No. 7.7 7 p'7 7-±/,^ ^r
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Signatu f applicant Address
�,
i Application date
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PLANNING AREA 5- F : DISTRICT 5- SCHOOL DISTRICTT
,3 WATER DISTRICT
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APPROVED BY
JEFFERSON COUNTY HEALTH DEPT a'�� \ " IIIIIIIIIIIIIL w `\,
APPROVED BY: PERMIT FEE ISSUE DATE' \\\ `�P\tERMIT NUMBER 1
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