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BUI LDING PERMIT APPLICATION
Jefferson CountY Bu ilding Department . County Courthouse . Port Townsend, Wash.98368 . 385-1310
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S W FROM INTERSECTION OF......-..---- ROAD AND
ROAD
#L
SubdivisionBlockLot
TownsonSectionU
landmark
NE
SW SIDE OF FEET
ROAD
l. LOCATIONi geographic name
NE
other specific location or
LEGAL DESCRIPTIOI\:t6l
II. 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?
E trtoE ves
TYPE OF TMPROVEMENT
X\ew burlding
'Ll Addition
fl Alteration
D Repair, replacement
I Wrecking
I Moving (relocation)
I Foundation only
BUILDING TYPE
$Qinsle Familv
'n Multi-Family
number of units
fl Hotel, Motel, Dormitory
number of units
l-l Mobile Home
fl Otr,er - Specify
USE A
XFull-tiorc Residence
E Second Home: Recreation Cabin, etc.
D Second Home: Future conversion to
permanent residenceUBC OCCUPANCY GROUP:
OWNENSHIP
)(rr,r"r" (individual, corporation,
/ nonprofit rnstitution, etc.l
fl Prutic (Federal, State or local gov'r.)
(Omit cents)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.
t
)
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
COST
,FARF SEWAGE DISPOSAL
\ fleguri" or Private
x--1'-. .Elndividual {septic tank, etc.)0
DIMENSIONS
olJumber of Storres
.Total square feet of floor area,
all floors, based on exterior
dimensions.
.Total land area, sq. ft
lndividual (well, cistern)
F WATER SUPPLY
or private company
III. SELECTED CHARACTERISTICS OF BUILDING .ltcC
PRINCIPAL TYPE OF FRAME
! Masonry (wall bearingl
D Ottrer - Specify
lwooa rrame
/fl Structural steel
! Reinforced concrete
NUMBER OF OFF.STREET
PARKING SPACES
Enclosed
OutdoorsTYPE OF FIREPLACE
RESIDENTIAL BUI LDINGS ONLY
Number of bedrooms
Full..
Partial
Number of
bathrooms
TYPE OF MECHANICAL
PRINCIPAL TYPE OF HEATING FUEL
E Gat
E oit
D Electricity
Dcoat
IV. IDENTIFICAT]ON
Tel. No.ZIP codeMailing Address - Number, street, city and StateName
+Owner
1
I CE I)SEte
2
Contracto
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws
Signat Application dateAddressican t
SCHOOL DISTRICT WATER DISTBICT-FIRE DISTNING AREA
R;s
APPROVED BY
JEFFERSON COUNTY H
7d3
PEBMIT NUMBERISSUE
lO1 d)
TEAPPBOVED BY
G OFFICIAL
PE RI\,lIT FEE4
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