HomeMy WebLinkAboutBLD1980-00184Eqo 6
BUI LDING PERMIT APPLICATION
Jefferson County Buitding Department . County Courthouse . Port Townsend, Wash.98368 . 385-7310
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I. LOCATION: geographic name
-
S W SIDE oF
LEGAL DESCRIPTIOf{
other specific location or landmark
FEET
ROAD AND BOAD
NE
S W FROM INTERSECTION OF
II. TYPE AND COST OF BUILDING
E Ne* County Resident
ls this structure to serve the residential
or commercial needs of those employed
at eather the U.S. Navy's Trident or
lndian lsland Facilities?
MOBILITY
E vrs Ewo
TYPE OF IMPROVEMENT
ffi"* buildins
n Addition
f] Alteration
D Repair, replacement
fl Wrecking
! Moving (relocation)
fl Foundation only
E Hotel, Motel, Dormitory
BUILDING TYPE
number of units
number of units
,DaSrngle Family
n Multi-Family
[-l Mobile Home
U Otner - Specify
USE
ftr',-,,n " Residence
E Second Home: Recreation Cabin, etc
D Second Home: Future conversion to
permanent residenceUBC OCCUPANCY GROUP:
fir9.irut" (individual, corporation,- nonorofit institution, etc.)
E Prbtic (Federal, State or local gov't.)
OWNERSHIP
(Omit cents)
IA O C
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, office building at industrial plant
lf use of existing building is being changed, enter proposed use.
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Cost of improvement.. .. . . . . .
To be installed but not included
in the above cost
a. Electrical.
b. Plumlcing.
c. Heating,airconditioning ......
d. Other (elevator,etc.)....... ...
TOTAL COST OF IMPROVEMENTa
cosT
a
LTYPE OF SEWAGE OISPOSAL
! Puotic or Private
'lV lndivrdual (septic tank, etc.),/6L*
7?2
DIMENSIONS
o I'lumber of Storres
oTotal square feet of floor area,
all floors, based on exterior
drmensions.
.Total land area, sq. ft
IIt. SELECTED CHARACTERISTICS OF BUILDING .
PRINCIPAL TYPE OF FRAME
fl other - SPecifY
! Masonry (wall bearing)
,pJAlood Frame
E Structural steel
! Reinforced concrete
NUMBER OF OFF.STREET
PARKING SPACES
Enclosed
Outdoors
TYPE^OF FIREPLACE\f--
Locro\ S\coe---s2
RESIOENTIAL BUI LDINGS ONLY
Number of bedrooms
Full..
Part ia I
Number of
bathrooms
TYPE OF MECHANICAL
PRINCIPAL TYPE OF HEATING FUEL
E G"s
E oit
EEtectricity h
Ecoat
E Other - Specify
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IV. IDENTIFICATION .
ZIP code Tel. NoMailing Address - Number, street, city and StateN ame
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4naOwnerK
3tq qnsete
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Contracto
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Architect
The owner of this building and the undersigned agree to conform to all applicable l6ws
Signatu Addressrca
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SCHOOL P151P1g1 5-O WATER DISTRICT-PLANNING AREA E DISTRICT
ISSUE DA'It
ttr -t B'-8o 3./3
PERMIT NUMBERPERMIT FEE
?ttNG OFFICIAL
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APPROVED BY
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TYPE OF WATER SUPPLY(-a.*1',v
'BPublic or private company
f] lndividual (well, cistern)
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Application datett_ r5-_ 7 o
JEFFERSON COUNI'I HEALTH
APPROVED BY
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