HomeMy WebLinkAboutBLD1975-000664ssf I
JEFFERSON COUNTY COMMISSIONERS
Port Townsend, Washington
BUILDING PERMIT APPLICATION
I-Health Dept,
,MPORIANI - Complete ALL irems. Mork 6oxes where opplicoble.
lLot. lB]i4z Cen su sdiviton,6
BUILDING
l.
LOCA
OF
-n s
;-feet E W from
)r4
tny6ect
(Other local geographic, political, or legal subdiuision identification)
arA4{.A-.c-/LQzn
._z,r')*ion of
NS
E W srdeof-
ll. TYPE AND COST OF BUI LDING - All oppliconts complete Ports A - D
A. TYPE OF IMPROVEMENT
r E-.vfuitaine
Addition (If residential, entet number
of new housinp units added, it any,
in Part D, 13)
Alteration (See 2 above)
Repair, replacement
Wreckrng (It muttitamily rcsidential,
enter number of unils in buildinp in
Part D, 131r
Moving (relocation)
Foundation only
3
6
7
zI
( individual, corporation
t institution, etc.)
g i--l Public (Federal, State, or
local Sovernment)
I
rof i
B. OWNERSHIP
D, PROPOSED USE - For "Wrecking" most .ecent use
26 f] School, library, other educational
2z f Stores, mercantile
28 [ Tanks, towers
zgf lother -Specify
Residentiql
-am i ly
Nonresidentiol
zo f_-l lndustrial
to [,] Transient hotel, motel,
or dorrnitory - Enter number
of uni /s ..>
-
t2
l3 Two or more family - Enter
number o[ units - - - - - +-
24
25
Office, bank, professional
Public utility
18
t9
Amusement, recreati onal
Church, other reli gious
23 f-l Hospital, institutional
2t
22
Parking garage
Service station, repair garage
(Omit cents)
S'lo. Cost of improvement
To be installed but not included
in the above cost
a. E lectrrcal
b. P lum brng
c. Heatint, air condrtron inB .
d. Other (elevator, etc.)
II. TOTAL COST OF IMPROVEMENT
c. cosT
'*Sm89
Nonresidentiol - Describe in detail proposed use of buildings, e.g., foodprocessint plant, machine shop, laundry building at hospital, elementary
school, secondary school, college, parochial school, parking garage for
department store, rental office building, office building at industrial plant
lf use of existing building is being changed, enter proposed use.
lll. SELECTED CHARACTERISTICS OF BUILDING - For new buildings ond odditions, complete Ports E - L;
for wrecking, complete only Port .J , for oll others skip to lV
LG. TYPE OF SEWAGE DISPOSAL
@Wrtc or private company
4l f_l lndividual (septic tank, etc.)29qn
J. DIMENSIONS
48. Number of stories
49. Total square feet of floor area,
all floors, based on exterior
dimens ions
50. Total land area, sq. ft.
E. PRINCIPAL TYPE OF FRAME
30 f] Masonry (wall bearinS)
3t frl w^rff7ame
Structural steel
Reinforced concrete
Other - Specity _
32
33
34
H. TYPE OF WATER SUPPLY
-a242',1-lfrbltc or private company
43 fl lndividual (well, cistern)K. NUMBER OF OFF.STREET
PARKI}lG SPACES
51. Enclosed
52. Outdoors
3
t-
F. PRINCIPAL TYPE OF HEATING FUEL
35 f_l Gas
3s f_l Coal
3s f Other - Specity
[-_-l oit
-ectricity
36
37
I. TYPE OF MECHANICAL
Will there be central air
conditionint?
44 T Yes 4sW6
Will there be an elevator?
46 f-l Yes az [e]-Nd
L. RESIDENTIAL BUILDINGS ONLY
53. Number of bedrooms
Full
Part ia I
54. Number of
bathrooms
I
lV. !DENTfFICATION - To be completed by oll oppliconts
Da.u Mailing address - Number, street, city, andState ZIP code Tel. No
-/-z /z7 },4J7I.
Owner
296 k(-/2.7
Con lroclor State License No.
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws ol (name of permit jurisdiction)
Addres s Application date
DO NOT WR'TE
'N
TH'S SPAC
gnature of ap plicant
FOR OFF'CE USE
by
/?rmit number
I
Perm t e sst
ts J_l Garase
to [l Carpon
tz [] Ottrer - Specity
s