HomeMy WebLinkAboutBLD1984-00128a ( c /a r/{r). S/ ,s 'J
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Jeflerson Building Department . CountY Courthouse . Port Townsend, Wash.98368 . 385'l3lO
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PERMIT FEE
IDE OFname
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I. LOCATION
ROAD AND
Lot
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2t)i{
S W FROM INTERSECTION OF
other speciltc leation or landmark:
ROAD
FEET
II. TYPE AND COST OF BUILDING
MOBILITY
f) N"* CountY Resident
ls this structure to serve the residential
or commercial needs of those employed
at either lhe U.S. NavY's Trident or
lndian lsland FacilitiesT
E ves v""
TYPE OF IMPROVEMENT
V ""* buildine/)Ll Addition
I Alteration
! Repair, rePlacemenl
f] Wrecking
! Moving (relocation!
! Foundarion onlY
E Mulri-Family
ntrmbet of units
-
Hotel, Motel, DormitorYtr
number of units
BUILDING
I Mobite Horne
! Ottter - SPecifY
psinsre ramilv
Cabin, etc.
toE Second Home: Future
Full-time Besidence
Second Home:
UBC OCCUPANCY GR
OWNERSHIP
ffi Priu"t" (individual, corPoration,7 t nonprofit inslitution,'elc.l
E Prutic (Federal, State or local gov't.)
(Omit cents)- 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
departmentstore,renta|officebuilding,officebuildingatindUstrialplanvr
tf use of existing building is being changed, enter proposed use' z ()t
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. Cost of improvement
To b installed but not included
in the above coEt
a. Electrical.
b. Plunlring.
c. Heating,airconditioning ......
d. Other (elevator, etc.l. . .
TOTAL COST OF IMPROVEMENT
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III. SELECTED CHARACTERISTICS OF BUILDING .t58,gctj
-
fTYPE OF SEWAGE DISPOSAL
ndividual (septic tank, etc.)
Public or Private
DIMENSIONS
. Number of Stories
. Total square feet of floor area,
all floors, based on exterior
d imensions .
.Total land area, sq- ftTYPE OF WATER SUPPLY
E Public or private comPany
,Kndividual (well, cistern)
PBINCIPAL TYPE OF FRAME
fl MasonrY (wall bearing)
{wooa r."t"
E Slructural steel
E Beinforced concrete
! Ottrer - Specify il/4NUMBER OF OFF.STREET
PARKING SPACES
Enclosed
OutdoorsTYPE OF FIREPL>fCE
/,00r)s6rre'
TYPE OF ME
RESIOENTIAL BUI LDINGS ONLY
Nurnber of bedrooms
Nunber of
bathrooms
PRINCIPAL TYPE OF HEATING FUEL
flGrs
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Dottt"t
oil
IV. IDENTIFICATION.
ZIP code Tel. Nostreet, city andress - NMaName
q 7aOryner
2.
Con
3.
Architect
the undersigned agree to conThe owner of this building form to all applicable laws.
Address
CT- WATER DTSTRICT-PLANNING AREA FIRE DISTRICT SCHOOL DIST
APPROVED BY . ./
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JEFFERSoN co{:w HE LTH oEf
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IT NUMBERPE
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ISSUE DATEOBY4
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LEGAL DESCBlPTION:
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Paftial.
1.
BUILDING
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