HomeMy WebLinkAboutBLD1979-00285o o #2s37,
BUI LD!NG PERMIT APPLICATION
Jefferson County Building Departmen t . County Courthouse . Port Townsend, Wash.98368 . 385-1310
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Block IE_35
Section7o SectionTax N Han
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l. LOCATIONi geographic name
SubdiviLEGAL DESCRIPTION
other specific location or landmark
NE
SW SIDE OF-FEET
ROADNE
S W FROM INTERSECTION OF-- ROAD AND
II. TYPE AND COST OF BUILDING
MOBILITY
E N"* 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?
E tttoE ves
TYPE OF IMPROVEMENT\-
{ltew buildins
E Addition
I Alteration
f] Repair, replacement
I Wrecking
I Moving (relocation]
E Foundatron only
D Hotet, Motel, Dormitory
number of units
ll Mobile Home
Xao,nu, - specifv
f] Frll -tinre Residence
[] Second Home: Recreation Cabin, etc
E Second Home: Future conversion to
permanent residence
USE
UBC OCCUPANCY GROUP:
OWNERSHIP
fl Private (individual, corporation,
nonprof it institution, etc.)
E prbtl" (Federal, State or local gov't.)
(Omit cents)
m
Nonresidential - Describe in detail proposed use of buildings, e.9., food
processing plant, machine shop, Iaundry 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.
5
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
cosr
a
a
TYPE OF SEWAGE DISPOSAL
I Pubtic or Private
n lndividual (septic tank, etc.)
DIMENSIONS
.lJumber of Stories
. Total square feet of floor area
all floors, based on exterior
drmensions.
.Total land area,sq. ft. ... ...TYPE OF WATER SUPPLY
D Pubtic or private company
I lndividual (well, cistern)
III. SELECTED CHABACTERISTICS OF BUILDING .
PRINCIPAL TYPE OF FBAIVIE
! Ottrer - Specity
f] Masonrv (wall bearing)
! Wood Frarne
E Structural steel
fl Reinforced concrete
NUMBER OF OFF.STREET
PARKING SPACES
Enclosed......
OutdoorsTYPE OF FIREPLACE
.4RESIDENTTAL BUI LDINGS ONLV
Number of bedrooms
Full..
Partial
Number of
bathrooms
TYPE OF MECHANICAL
PRINCIPAL TYPE OF HEATING FUEL
fl Gas
E oir
D Electricity
D Coat
f] Othe, - Specily
IV. IDENTIFICATION.
ZIP code Tel. No.Mailing Address - Number, street, city and StateName
7Owner
te
2
Contracto
3.
Architect
The owner of this building undersigned agree to conform to all applicable laws.and the
Application dateAddressSignatican t
E DISTRICTPLANNING AREA
)'JEFFERSON COUNTY HEALTH DEPT
APPROVED BY
ISSUE DATE
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PERMIT NUMBERPERTVIIT FEE
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APPROVED BY
G OFFICIAL
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Lot
BUILDING TYPE
D Single Family
E Multi-Family
number of units
SCHOOL DISTRICT- WATER DISTRICT-
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