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HomeMy WebLinkAboutBLD1988-00168 r BUILDING PERMIT APPLICATION Jefferson County Buildirpartment• County C1nurthouse • Port Towr!, Wash.98368 • 385-9141 4 N E I. LOCATION: geographic name S W SIDE OF ROAD FEET NE S W FROM INTERSECTION OF ROAD AND „,7 . en IJROAD other specific location or landmark: 0 Le 0 . MI Clq. _ 3,7 / L LL C2ES TION: �'V�1 C Lot Bock Subd C)A-.) (k....) 3 r y 0��,� Tax Number Yn Section Section �TT000wwwnnnship CxR)ange II.T A COST OF BUILDING - TYPE F IMPROVEMENT BUILDING TYPE MOBILITY ( New building Single Family ❑New County Resident `' ❑ ddition Multi-Family Is this structure to serve the residential El Alteration number of units or commercial needs of those employed ❑Hotel,Motel, Dormitory at either the U.S.Nav ❑Repair,replacement number of units Indian Island Facilities? s Trident or ❑Wrecking ❑Mobile Home ❑Moving (relocation) ❑Other-Specify ❑YES ❑NO ❑Foundation only USE OWNERSHIP ❑Full-time Residence ❑Private (individual,corporation, nonprofit institution,etc.) ❑Second Home: Recreation Cabin,etc. ❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: 1' ' ❑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 Wit iv.. // q, c 3c -7,,�? c. Heating,air conditioning lop cet a `-rn`` Q� -?A d. Other (elevator,etc.) l�C �� CJ • TOTAL COST OF IMPROVEMENT $ FM\ 6 0377 III.SELECTED CHARACTERISTICS OF BUILDING - PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DI I M E •IONS ❑Masonry (wall bearing) A u• ber of Stories • Li or Private ( -_� •Total square feet of floor area, Wood Frame ^htl ndividu (septic tank,jetc.) all floors,based on exterior ❑Structural steel dimensions TY W SUPPLY ❑Reinforced concrete •Total iand area,sq.ft. ublic or pr. to company _ ❑Other-Specify - l NUMBER OF OFF-STREET Individual (well,cistern) PARKING SPACES Enclosed PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE ❑Gas Outdoors 0 Oil RESIDENTIAL BUILDINGS ONLY Electricity Number of bedrooms ❑Coal TYPE OF MECHANICAL .XO her- pe y Number of Full J bathrooms l t/ Partial IV. IDENTIFICATION - Name Mailing Address—Number,street,city and State ZIP code Tel.No. . ia_c---) c- , Pii\ocl ,_, a., -6Rao co P-idk 2. Contractor State License No. I 3. Architect r The owner of this building and the undersigned agree to conform to all applicable laws. • xsignature bf applicant Add?re Appli lion ate . =ill �.�„ ( �. - c�,�, l PLANNING AREA FIRE DISTRICT SCHOOL DIST T ,.WATER DISTRICT APPROVED BY�iG fte, ,.- (P JEFFE *1 �C UNTY HIALTH DEPARTMENT /Zt APARP ,• I'% ft (PERMIT FEE ISSUE E ' FtEC6fPT NUMBER , ��', JUL 1 ,a 7///t Ci- 1 PLANNING&BIOS DEPT s `` %e ' ery-Port Townsend7-0 % j// j) Jul2 :: qo, brtVeuJaio. As Slops, 3-4 i 4 4Si-µ 4s.3 y: Re. 3 55 c 3 } RCS .L 35 r 3 $ aPt.; i 3�Y.3 3arct © CJ y propascc�' o me . As/ ' 5,4 � ,J b� /ent A 7s'Xt' i _ t _ Slt►13Lf, Z/vi. a Sit- / _ -4