HomeMy WebLinkAboutBLD1980-00182<K o>BUI LDING PERMIT APPLICATION
Jefferson CountY Euilding Department . County Courthouse . Port Townsend, Wash.98368 . 385-1310
ROAD
Larooks Sl-{ofJ__plnr
Block
Towni6fp RangeSectionTax Number
tr3{ .?x A/'
other specific location or landmark
FEET
S W FROM INTERSECTION OF
NE
S W SIDE OF
LEGAL DESCRIPTION: a
Lot
ROAD AND ROAD
l. LOCATIONi geographic name
NE
II. TYPE AND COST OF BUILDING
MOBILITY
E Ne* Countv 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?
n ves b{
TYPE OF IMPROVEMENT
p'1t"* building
n Addition
I Alteration
fl Repair, replacement
! Wrecking
I Moving (relocation)
n Foundation only
fl Hotet, Motel, Dormitory
number of units
[l Moqlte Home
g{n* - Specify
@
number of units
BUILDING TYPE
E Single Family
n Multi-Family
USE ,
ffiutt-tin're Residence
E Second Home: Recreation Cabin, etc.
Esecond Home: Future conversion to
permanent residenc€UBC OCCUPANCY GROUP:
-
owNEr6HrP
ffPrir"t" (individual, corporatron,
nonprof it institution, etc.)
E Pruti" (Federal, State or local gov't.)
(Omit cents)
$
O
o
G RQE,* h ttrcr'
$r 50c
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
ITYPE OF SEWAGE DISPOSAL
tffi:.
orprivate A/ 0M
ual (septic tank, etc.)370
3'7 (\
DIMENSIONS
.lJumber o{ Storres
. Total square feet of floor area,
all floors, based on exterior
dimensions.
.Total land area, sq. ftTYPE OF WATER SUPPLY
! Pubtic or private company
S/aiviouat (well, cistern )
III. SELECTED CHARACTERISTICS OF BUILDING -
l-l Rejnforced co-6.n , -spe.i
ncrete
lyPlesTtc o
o
NUMBER OF OFF-STREET
PARKING SPACES
Enclosed
Outdoors
TYPE OF FIREPLACE
O c
c
RESIOENTIAL BUI LDINGS ONLY
Number of bedrooms
I
I
Full..
Partial
Number of
bathrooms o
TYPE OF MECHANICAL
PRINCIPAL TYPE OF HEATING FUEL
E Gas
fl oir
D Electricity
fl coat
6n", - Speciry NON4
IV. IDENTIFICATION -
ZIP code Tel. NoMailing Address - Number, street, city and StateName
411-c 1Q*q LfqrAP Ri. / t3oxqq2c. Pt.Lodlawi.Fq,N/CLAI'?71
Owner
3/\ Iu<
Itate Licerrse No.
ou/AJeR
2.
contractor
3.
Arch itect
The owner of this building and the undersigned agree to conform to all applicable laws
Add\ess
,1t 7rr" 4tt 2 A ?i (,LI
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U
Application date
t].'Lt) r
Signature of applicant
;,, , Lr
-3 scHooL DrsrRrcr 4/ ? wArER DrsrRrFE DISTRICT
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JEFFERSON COUNTY HEALTH DEPT
ANNING AREA
PPROVED BY c,
.-3.'e-i
PERMIT NUMBERPE RIVI IT FEE
tsP
ISSUE DATE
t 23-80
BUIL,/NG OFFICIAL
APPROVED BY
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Nonresidsntial - 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, office building at industrial plant.
lf use of existing building is being changed, enter proposd use.
PRINCIPAL TYPE OF FRAME
I Masonry (wall bearing)
! Wood Frame
I Structural steel
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