HomeMy WebLinkAboutBLD1980-0018368%
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BUILDING PERMIT APPLICATION
Jefferson County Building Department. County Courthouse . Port Townsend, Wash.98368 . 385-1310
PE RMIT FEE
l. LOCATIONi seographic name
NE
NE
S W SIDE OF ROAD FEET
ROADS W FROM INTERSECTION OF ROAD AND
T- cco..\a.\ e \ sr )e-et &t C \n,.,tr<-\other specific location or landmark
LEGAL DESCRIPTION L
Lot Block on
Tax Number 7n Section Section Township Range
II. TYPE AND COST OF BUILDING
TYPE OF IMPROVEMENT
E tJew building
Efaaai,ton
! Alteration
D Repair, replacement
fl Wrecking
! Moving (relocation)
! Foundation only N
MOBILITY
fl Ne* County Resident
ls this structure to serve the residential
or commercial needs of those employed
at either the U.S. Navv's Trident or
lndian lsland Facilities?
E ves E rrro
USE
BFull-tinre Residence
D Second Home: Recreation Cabin, etc.
E Second Home: Future conversion to
permanent residence
OWNERSHIP
ffPrivate (individual, corporation,
nonprof it institution, etc.)
E Prbti" (Federal, State or local gov't.)UBC OCCUPANCY
cosr
. 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
lOmit cents)
$
Nonresidential - Describe in detail proposed use of buildings, e.9., food
processinq plant, machine shop, laundrv 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.
$
III. SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAtvIE
I Masonry (wall bearing)
[}Wood Frame
fl Structural steel
I Reinforced concrete
TYPE OF SEWAGE DISPOSAL DIMENSIONS
.lJumber of Stones
. Total square feet of floor area
all floors, based on exterior
dimensions.
.Total land area,sq. ft. ... . ..
L[f Puotic or Private
D lndividual (septic tank, erc.)t300
E Ottrer - Specify
' "E;:,l:.',T :Y:::t "r"t FD lndividual (well, cister NUMBER OF OFF-STREET
PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
fl Gas
D oit
n Electricity
E coal
E Ottt"r - Specify
oA S\Or<-Outdoors
L RESIOENTIAL BUILDINGS ONLY
Number of bedrooms
TYPE OF MECHANICAL
Number ol
bathrooms
Full..
Part ia I
IV. lDENTIFICATION.
Name Mailing Address - Number, street, city and State ZIP code Tel. No
,l
Owner
'Y'[\arrr'. fl '-R.rt - 8=x l5-r-36'r-
Ccr^r+<^r Poe.f fr^.oseh\Qtser 26r/[
a
Contractor
/<//
State License No
2
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Address Application date
3-s -8-O
SCHOOL DISTRICT /-i ? WATER DISTRICT-FIRE DISTRICTPLANNING AREA
APPROVED BY
JEFFERSON COUNfr HEALTH E)EPT db<tu n)c* R.rrtl'-, NLQ- oK-ffioGr._tssuE DA{E-.
s 2q-Fc
BLIILDING OFFICIAL/
PERMIT NUMEER4o/rY
BUlLOING TYPE
Dticste Famity
n Multi-Family
number of units
n Hotel, Motel, Dormitory
number of units
[l Mobile Home
E Ottrer - Specify
I
I
2
applicant,
I