HomeMy WebLinkAboutBLD1978-00167BU! LDING PERMIT APPLICATION
Jefferson County Building Department c County Courthouse . Port Townsend, Wash.98368 . 385-1310
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SubdivisionBlock R: ,.^)
Tax Number % Section
ROAD
{.e
Lot 2A l')
Township Range
l. LOCATION: gEographic name
6rr Lc^ ?z f e\ a.r..\-
FEET
LEGAL DESCRIPTION
other specific location or landmark:
2U
Section
NE
SW SIDE OF
ROAD AND ROAD
NE
SW FROM INTERSECTION OF
II. TYPE AND COST OF BUILDING.
E New County Resident
ls this structure to serve the residential
or commercial needs of those employed
at either the U.S. Navy's Trident or
lndian lsland Facilities?
MOBILITY
flves Eno
TYPE OF IMPROVEMENT
E New building
E Aaditton
! Alteration
D Repair, replacement
! Wrecking
I Moving (relocation)
E-Foundation only
E Single Family
D Multi-Family
number of uni* _
E Hotel, Motel, Dormitory
number of units
[ELMobile Home
E Otfrer - Specify
BUlLDING TYPE
OWNERSHIP
fr.Private (individual, corporation,
nonprof it institution, etc.)
E Publlc (Federal, State or local gov't,)UBc occUPANcY GRoUP: -K-
USE
f] Frll-ti-e Residence
Fsecond Home: Recreation Cabin, etc.
E Second Home: Future conversion to
permanent residence
(Omit cents)
$
s2ocrr->
Nonresidential - Describe in detail proposed use of buildings, e.9., food
processing plant, machine shop, laundry building at hospital, elementary
school, secondary school, college, parochial school, parking garage for
department store, rental off ice building, off ice building at industrial plant
lf use of existing building is being changed, enter proposed use.
a Costof improvement,...,....
To be installed but not included
in the above cost
a. Electrical.
b. Plumbing.
c. Heating,airconditioning ..,...
d. Other (elevator, etc.). . ,
TOTAL COST OF IMPROVEMENT
cosT
a
I!!. SELECTED CHARACTERIST!CS OF BUILDING -
/TYPE OF SEWAGE DISPOSAL
n Pubtic or Private
Q tndiviauat (septic tank, etc.)28xt/o
DIMENSIONS
. Number of Stories
.Total square feet of floor area,
all floors, based on exterior
d ime n sions .
.Total land area, sq. ft lH /4
PRINCIPAL TYPE OF FRAME
! Masonry (wall bearing)
I Wood Frame
! Structural steel
! Reinforced concrete
E Otner - Specify
TYPE OF WATER SUPPLY
D Public or private company
E lndividual (well, cistern)NUMBER OF OFF-STREET
PARKING SPACES
Enclosed
Outdoors
TYPE OF FIREPLACE
2
I
PRINCIPAL TYPE OF HEATING FUEL
DGas
E oir
ffiElectricity
n coal
fl oth". - specifv
TYPE OF MECHANICAL
RESIDENTIAL BUI LDINGS ONLY
Number of bedrooms
Full. .
Partial
Number of
bathrooms
IV. IDENTIFICATION.
Mailing Address - Number, street, city and State ZIP code Tel. NoName
6BSZgttR.b.+r LenX *t ?t. Z B,at: Q'4I.1
Owner S-n6
State License No
2.
Contractor
3.
Architect
di undersigned agree to conform to all applicable laws.The
Application dateAddress
l6 2 SCHOOL DISTRrcT 4 B WATER DISTRIPLANNIAREAFIRICT
APPROVED BY ok ?--
OLYMPIC HEALTH DISTRICT
7- t''75c\"<-
FEE IY/;*
ISSU-DATE
] -s-zq 225/
PERMIT NUMBER
LDING OFFICIAL
APP BY
The Printery - Port Townsend
AJ
HEALTH
INSTATTER
zuILDGR
COMMENTS:)liTr
sErl,AoE plsPos*l Eqult
PORT TgW
(,A
Submit in Dupllcate
,)
tttt t 4R apr
Directions for locatlng eite
INSTALL NEW SYSTEM HEPLACE SYSTEM E "PNNTIAL REPAIB fJ T
wPE oF n Ol
,r L A(E
Owner Address
l{6 No. oF
- 2i--- --srse r'aLur tV
LED P!-OT PLAN BELOW. STUB OUT LUMBING ABOVE FOUNDATI FOOTING
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APPLICANT
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DATE INSPECTED P
I certlfy that
. .l
thls system wasth stalled ln a manner approved
INSTAI-LER'S SIGN
JCHD/1.78
TURE DATE
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