HomeMy WebLinkAboutBLD1988-00329! :
BUILDING PERMIT APPLICATION '
Jefferson County Buildinp artment• County Courthouse •Port TownsSWash.98368 • 385-9141
N E •
I. LOCATION: geographic name S W SIDE OF ROAD FEET
S W FROM INTERSECTION OF ROAD AND. l O 0 PC40r (i/It ea.) iT ROAD
other specific location or landmark: I-) 1
LEGAL DESCRIPTION: 1)I V 9
Pa reel 1.,L_ Lot Block 2...51.3.____ SubdivfsTon
q (Q,�000 ,3 Zi Tax Number Y.Section Section Township Range
II. TYPE AND COST OF BUILDING-
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
❑New building ❑Single Family ❑New County Resident
Addition ❑Multi-Family Is this structure to serve the residential
❑Alteration number of units or commercial needs of those employed
❑Hotel,Motel, Dormitory at either the U.S.Navy's Trident or
❑Repair,replacement number of units
Indian Island Facilities?
❑Wrecking ❑Mobile Home
❑Moving (relocation) Other—Specify
El YES ❑NO
❑Foundation only +
USE
OWNERSHIP
❑Full-time Residence
❑Private (individual,corporation,
nonprofit institution,etc.) ❑Second Home: Recreation Cabin,etc.
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP:,-3 ❑Second Home: Future conversion to
permanent residence
COST (Omit cents) Nonresidential— Describe in detail proposed use of buildings,e.g.,food
• Cost of improvement $ processing plant,machine shop,laundry building at hospital,elementary
To be installed but not included school,secondary school,college,parochial school,parking garage for
in the above cost department store,rental office building,office building at industrial plant.
a. Electrical If use of existing building is being changed,enter proposed use.
;, b. Plumbing
c. Heating,air conditioning
d. Other (elevator,etc.)
• TOTAL COST OF IMPROVEMENT $
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME •
TYPE OF SEWAGE DISPOSAL DIMENSIONS
Masonry (wall bearin ► •Number of Stories
❑ 9 ❑Public or Private
•Total square feet of floor area,
4 ❑Wood Frame ❑Individual (septic tank,etc.) all floors,based on exterior
0Structural steel dimensions
TYPE OF WATER SUPPLY
❑Reinforced concrete •Total land area,sq.ft.
�' ❑Other—Specify CI Public or private company
❑Individual (well,cistern) NUMBER OF OFF-STREET
PARKING SPACES
-"` Enclosed
- PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY
❑Electricity Number of bedrooms
❑Coal TYPE OF MECHANICAL
❑Other—Specify
Number of Full
bathrooms
Partial
IV. IDENTIFICATION - •
Name Mailing Address— Number,street,city and State ZIP code Tel.No.
f. lTO('� L FnI nlY) 1(0 C C(710 1 ti l0(c_' Or( UF,) PT (-1P 10P) -- -Zic-I0
Owner
2.
Contractor State License No.
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
//
$ign re of�pplicant q Address Application date
v1.-- 11 �r Qom_ ,3,--a---ri\SL-- C,C','. '/
1.
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY
JC F I rt QJ C LJ HEALTH DEPARTMENT
AP i A - PENRMIT FEE ISSUE DATE RECEIPT NUMBER
'(Al rr'3 ii 1988 ® V rl _ 3 / t :
BUI LOOM kFRR0(lit: TY �`
PI.ANNINM&BIDG DE PT ' 50
The Printery—Port Townsend