HomeMy WebLinkAboutBLD1978-00170BUI LDING PERMIT APPLICATION
Jefferson County Building Department . Countv Courthouse . Port Townsend, Wash.98368 . 385-1310
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S W SIDE OF
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% Section TownshipTax Number Section
Lot Block ,e lv
Range
LEGAL DESCRIPTION:
S W FROM INTERSECTION OF
other specific location or landmark
, FEET
ROAD
Subdivision27N
I!. TYPE AND COST OF BUILDING .
MOBILITY
E Ne* 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?
D Yes ff'ro
TYPE OF IMPROVEMENT
[ltew building/Z Addirion
E Alteration
E Repair, replacement
! Wrecking
I Moving (relocation)
f] Foundation only
BUILDING TYPE
E$ngre Famttv
E Multi-Family
number of units _
E Hotel, Motel, Dormitory
number of units
I Mobite Home
E Otfrer - Specify
UBC OCCUPANCY GROUP:-
USE
\d'- .
/lz-\l-trme Hesrdence
E Second Home: Recreation Cabin, etc
Esecond Home: Future conversion to
p€rmanent residence
OTfUNERSHIP
ffiivate (individual. corporation,
nonprof it institution, etc,)
n Pubtic (Federal, State or local gov't.)
(Omit cents)
b. Cost of improvement,. ... ....
To be installed but not included
in the above cost
a, Electrical.
b. Plumbing.
c. Heating,airconditioning ......
d. Other (elevator, etc.). . .
TOTAL COST OF IMPROVEMENT
cosT
sa 2,aad
Nonresidential - Describe in detail proposed use of buildings, e.9., food
processing plant, machine shop, laundry building at hospital, elementary
school, secondary school, college. parochial school, parking garage for
department store, rental office building, off ice building at industrial plant.
lf use of existing building is being changed, enter proposed use.
III. SELECTED CHARACTERISTICS OF BUILDING -
TYPE OF SEWAGE DISPOSAL
n Pubtic or Private
F\aiviOuat (septic tank, etc.)
/o5€
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DIMENSIONS
o Number of Stories
.Total square feet of floor area,
all floors, based on exterior _dimensions. . ....?A4.
0
.Total landarea,sq.ft.,.........
PRINCIPAL TYPE OF FRAME
! Masonry (wall bearing)
XWood Frame
! Structural steel
! Reinforced concrete
E Otner - Specify
TYPE OF WATER SUPPLY
! Public or private company
E lndividual (well, cistern)
I
NUMBEB OF OFF.STREET
PARKING SPACES
Enclosed
Outdoors
TYPE OF FIREPLACE
-3
TYPE OF MECHANICAL
RESIDENTIAL BUI LDINGS ONLY
Number of bedrooms
Full. . .
Partial.
Number of
bathrooms
PRINCIPAL TYPE OF HEATING FUEL
E G"s
[] oit
.PfEl"",.i"i,v
ECoal
E Oth", - Specify
IV. IDENTIFICATION -
Name Mailing Address - Number, street, city and State ZIP code Tel. No
1
Owner
rL*J a vfi {2-693t9(7 C)
02
contractor state Ltcense No.
3.
Architect
The owner of this buildhS and-$.e undegigned agree to conform to all applicable laws
/
Sigrpture of applicant ress date
WATER DISTRPLANNING AREA IISTRICT SCHOOL DISTRICT
APPROVED BY
OLYMPIC HEALTH DISTRICT
ISSUE DATE
*/rr 2 o 79-'
PERMIT NUMBER
BUILDING OFFICIAL
APPROVED BYJ PERMIT FEE
109, o 6
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