HomeMy WebLinkAboutBLD1981-00119Da
BUI LDING PERMIT APtrLICATION
Jefferson County Buitding Department. Countyl:ourthouse ' Port Townsend,
q4-kv
Wash.98368 . 385-1310
NE
ROAD
ROAD AND
Block
ffi,tbs ld) /Tax Number '/n Section
_35
Section owns hip
l. LOCATION: seographic name
-
S W SIDE oF
tvts to
other specific location or landmark
LEGAL DESCRIPTION
, FEET
ROAD
NE
S W FROM INTERSECTION OF
II. TYPE AND COST OF BUILDING
fi ruew 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?
MOBILITY
E ves Elro
TYPE OF IMPROVEMENT
E[N"* building
fl Addition
I Alteration
! Repair, replacement
fl Wrecking
! Moving (relocation)
I Foundation only
I Hotel, Motel, Dormitory
UBC OCCUPANCY GROUP:
BUILDING TYPE
number of units
number of units
ffisingle Family
n Multi-Family
f_l Mooite Home
E Otner - Specify
El Full-time Residence
fl Second Home: Recreation Cabin, etc
D Second Home: Future conversion to
permanent residenc€
USE
f,BPrivate (individual, corporation,
nonprof it institution, etc.)
f] Prbtic (Ferleral, State or local gov't.)
OWNERSHIP
(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, otfice building at industrial plant
lf use of existing building is being changed, enter proposed use.
x
XA
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
COST
a $
TYPE OF MECHANICAL
O
22,befu
TYPE OF FIREPLACE
.Total land area, sq. ft.
Outdoors
n Otfrer - Specify
PRINCIPAL TYPE OF HEATING FUEL
Full..
Part ial
Number of
bathrooms
DIMENSIONS
.lJumber of Stories
. Total square feet of floor area,
all floors, based on exterior
drmensions.
NUMBER OF OFF.STREET
PARKING SPACES
E ncl osed
RESIDENTIAL BUI LDINGS ONLY
Number of bedrooms
TYPE OF WATER SUPPLY
I Public or private company
p.l ndividuat (well, cistern )
TYPE OF SEWAGE DISPOSAL
E Pubtic or Private
E lndividual (septic tank, etc.)
PRINCIPAL TYPE OF FRAME
! Masonry (wall bearing)
ffWooa Frame
D Structural steel
! Reinforced concrete
D G",
E oit
ffiEt""tri"ity
Dcoat
E other - Specifv
IV. IDENTIFICATION.
ZIP code {el. NoNameMailing Address - Number, street, city and State fun99i>cDir,.^.. l{co",,'l .
Owner J
'/g>2/ez-<)(Y\e, c)s2.
Contractor dr\(Yf State License\Dao.
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws
Application dateAddressa ppl ican t
PLANNING AREA FIRE DISTRICT RICT DISTRICT-
Signat
L
EAL L
EDAP B (
?2
ISSU DATE PERMIT NUMEEBiltt
.{yLotNc ocr
/')tuAPPROVED 8Y
ICIAL
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tol-
oa-
I\
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a-
PERMIT FEE
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IE
Range
IIt. SELECTED CHARACTERISTICS OF BUILDING .
)
I
o I
INSTALLER /-)ion.
tsUILDER
JEFFERSON COUNTY HEALTH DEPARTMENT
802 SHERIDAN AVENUE
PORT TOWNSEND, WASHINGTON 98368
(206) 38s.0722
SEWAGE DISPOSAL PERMIT
Submil in Duplicale
- )104iW$'ie
RECEIPT NO.-:,/ /o
a,/<DATE ,.. .. ,', ,.! V c,
')
)wner
s lor,localing site
tnil€ Tu, ' r
Address
(unr,TJ
, Apu
6r"vtl
"Tzltse-t
Phone
5
,a
TANI(DRAINF!ELD !
.)irection
4e l,,'1rl/,t
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dc(.ttt O/,/r, I
INSTALL NEW SYSTEM REPLACE SYSTEM f] PARTIAL REPAIR
rYPE OF
,]UILDING ?Jy',,NO. OF
BEDROOM IS BASEMENT
SITE) SIZEYe
DRAW DETAILED PLOT PLAN BELOW. STUB OUT PLUMBING ABOVE FOUNOATION FOOTING
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SOIL LOGS
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sIoz
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ro{
lo
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6\i
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3
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c.
Dig two hgles per site. (nrin.)
4' doep - 2' dia. - 5O' apart & tlag
'L^re^t
LAPPLICANT
Ot\?t9s0
-lLl.valr /
INY CHANGE IN BUILDING OR SEWAGE DISPOSAL PLANS (INCL
OCATION) AND/OR LOCATION OF HOUSE OR DRAINFIILD INVA,RIOR APPROVAL IS OBTAINED F
Drainli ld Le width
CO
/)Ovt ?
UDING PLUMBING STUBOUT
L I OAT.IS THI S PE
-d ()<-/R},IIT UNLESS
l-r*qngs-3- Tank Slze-t00l)- Gal.
1i? 61 (rwo coMPARTMENTS)
-)h J t;0 "r.^)
e
A ED DATE INSPECTED PARTIAUFINAL OATE
, cerli hat this system was installed in a manner approved by the Heallh Deparlment
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INSTALLER.S SIGNATURE
JCHD/I 78
DATE DATE INSTALLED
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