HomeMy WebLinkAboutBLD1980-00186I I 11 7r?3
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BUI LDING PERMIT APPLICATION
Jefferson CountY Euilding Department. CountY Courthouse . Port Townsend, Wash.98368 . 385'1310
PERMIT FEE
ROAD
Aa-
SectionTax N
o
4-Block
other specific location or landmark
LEGAL DESCRIPTIOhI
FEET
S W FROM INTERSECTION OF
NE
S W SIDE OF
ROAD AND ROAD
l. LOCATIONi geographic name
NE
II. TYPE AND COST OF BUILDING
MOBILITY
f] 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?
nruoE ves
TYPE OF IMPROVEMENT
F ruew buildins
E Adaition
I Alteration
D Repair, replacement
! Wrecking
! Moving (relocation)
n Foundation only
Ssinsle Family
! Multi-Family
number o'f units
-
! Hotel, Motel, Dormitory
number of units
I Mobite Home
D Other - Specify
BUILDING TYPE
usE >PeC
f.] Full-tln-," Residence
D Second Home: Recreation Cabin, etc
E Second Home: Future conversion to
permanent residenceuBc occuPANcv cnouP, -85-
OWNERSHIP
)d Priu"," {individual, corporation,
nonprof it institution, etc.)
D Prbti" (Federal, State or local gov't.)
(Omit cents)Nonresidential - Describe in detail proposed use of buildings, e.9., food
processing plant, rnachine 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.
2o686>s
a
q
4
d)
6s
517 (
. Cost of improvement
To be installed but not included
in the above cost
a, Electrical.
b. Plurr{cing.
c. Heating,airconditioning ......
d. Other (elevator. etc.). . .
. TOTAL COST OF IMPROVEMENT
COST
.LrxIFTbr SEWAG E DI SPOSA L
( Brro,," or Private C6r'r^
E lndividual (septic tank, etc.)q
DIMENSIONS
. lJ umber of Storres
.Total square feet of floor area
all floors, based on exterior
dimensions.
.Total land area, sq. ft
PRINCIPAL TYPE OF FRAME
I MasonrY (wall bearing]
f,Wood Frame
f] Structural steel
D Reinforced concrete
III. SELECTED CHARACTER!STICS OF BUILDING -
E Ottrer - Specify NUMBER OF OFF.STBEET
PARKING SPACES
Enclosed
Outdoors
TYPE OF FIREPLACE 2
itra Sion<-
.-3
TYPE OF MECHANICAL
RESIDENTIAL 8UI LDINGS ONLY
Number of bedrooms
Full..
Part ial
Number of
bathrooms
PRINCIPAL TYPE OF HEAT]NG FUEL
D Ga.
E oit
p€tectricity
D coat
4o,n", - Specify U)C\\
IV. IDENTIFICATlON
ZIP code Tel. NoMailing Address - Number, street, city and StateName
3L<_4fq 26-4
1.
Owner
rcense
2.
Co
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Address Application date-/r-Signature of applicant
WATER DISTBICTISTRICTOOL DISTRICTPLANNING AREA
APPROVED BY
JEFFERSON COUNTY HEALTH
s4c
PERMIT NUMBER)ISSUE DATE
t-n-80d.rAPPROVED BY
NG OFFICIAL
n/"1 \q{,e
company
cistern )