HomeMy WebLinkAboutBLD1986-00124 BUILDING PERMIT APPLICA T VV '
Jefferson County Buil Department• County Courthouse • Port Tend, Wash.98368 • 385-1310
I. LOCATION: geographic name-- S W SIDE OF —ROAD FEET
NE
S W FROM INTERSECTION OF ROAD AND c ,gyp -ROAD
2
other specific location or landmark: ✓0 S „
I ' ` Shc l eU OL.1__�L J i m6 W8
LEGAL DESCRIPTION:
Lot Block dub v ion
4egito4c02- -F,-,L)(. 1
Tax Numbe '/,Section _ Section i Township Range
II. TYPE AND COST OF BUILDING-
TYPE OF IMPROVEME BUILDING TYPE MOBILITY
❑New building ( Single Family ❑New County Resident
❑Addition *pla Le. ❑Multi-Family Is this structure to serve the residential
❑Alteratio (s-+( number of units ------- or commercial needs of those employed
❑Repair,re.acement A ❑Hotel,Motel,Dormitory at either the U.S.Navy's Trident or
number of units Indian Island Facilities?
❑Wrecking Mobile Home
❑Moving (relocation) 0 Other-Specify ❑YES ❑NO
❑Foundation only
W bl IS. — 1M ao
USE
OWNERSHIP ❑Full-time Residence
El Private (individual,corporation, ✓'
nonprofit institution,etc.) /-� ❑Second Home: Recreation Cabin,etc.
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: 3 ❑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 fZ x 5/ l i et 8 7
c. Heating,air conditioning (,b e' VleLv1 y IMo'PC f a .
d. Other(elevator,etc.) r [mq Q 1d mob 1 l e
• TOTAL COST OF IMPROVEMENT $
III.SELECTED CHARACTERISTICS OF BUILDING - \\qq,7§
PRINCIPAL TYPE OF FRAME TYPE S WAGE Dt$tbSA DIMENSIONS
(wall bearing) ❑ `� � •Number of Stories
L]Masonry 9 Pub is or ovate
•Total square feet of floor area,
❑❑Wood Frame
—
1 Individual se tic tank, tc.) all floors,based on exterior
Structural steel dal l I dimensions x
❑Reinforced con�re a l TYPE OF WATER SUPPLY •Total land area,sq.ft.
❑Other Specify ❑Public or private company
Individual (well,cistern) OF OFF-STREET
PARKING SPACES
Enclosed
PR\INN 'PAL TYPE OF HEATING FUEL TYPE OF FIREPLACE !-
Gas Outdoors
/❑"Oil RESIDENTIAL BUILDINGS ONLY
❑Electricity Number of bedrooms !/' `
❑Coal TYPE OF MECHANICAL
Number of Full
Other-Specify —
bathrooms
Partial
IV. IDENTIFICATION -
_
Name Mailing Address- Number,street,city and State ZIP code Tel.No.
1. R 1499 I _ S Kure ga ) Chalk. ce 32$ 73 2
Owner
2. e1-� _
Contractor State License No.
3.
Architect
T net of this building and the undersigned agree to conform to all applicable laws.
Ailla.,, rSigna .re of appli :� Address
Application
44.1 "..14 4 a.4( 1 / 1 / 11/./
PLANNING AREA FIRE DIST, ' wy CHOOL DISTRICT WATER DISTRICT
APPROV s — ` _ s 2 r12,....n�E��(�� Defyr ul?,'Z°b
.- ., �� i. nt„z
. Jc.FFER'. iiy:1.+, � 'C- "``-
APPRC -- 1oi ft�� PERMIT FEE ISSUE DATE RECEIPT NUMbc::R
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1. M.(118(0, u ,, Ite5888
BuiL()1NG OFFlCIPMy °11 jf. -,tip, /
The Printery --Port Townsend 70 HO /I J/7
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