HomeMy WebLinkAboutBLD1988-00330 --7
BUILDING PERMIT APPLICATION
Jefferson County Building Dei rent• County Courthouse • Port Townsend,ah.98368 • 385-9141
N'E
I. LOCATION: geographic name S W SIDE OF ROAD FEET
NE
S W FROM INTERSECTION OF ROAD AND )cf(C' CCi V I c Od ROAD
other specific location or landmark:
LEGAL DESCRIPTION: \
Pac 1-4 Lot Block Subdivision
i(I I OQ5 - �r= `� 1 t�
Tax Number /a Section Section Township Range
II.TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
i
lew 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
❑Repair,replacement ❑Hotel,Motel, Dormitory at either the U.S.Navy's Trident or
number of units Indian Island Facilities?
❑Wrecking
❑Mobile Home
❑Moving (relocation) �/
Ind Other-Specify
\. ❑Foundation only T` ❑YES ❑NO
,t\--) 1Ci,.1-,Lc e_ 7 5jlC,(.p
`� 1 1 USE
\7 OWNERSHIP
�r ❑Full-time Residence
V ❑Private (individual,corporation,
nonprofit institution,etc.) ❑Second Home: Recreation Cabin,etc.
O ❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: ❑Second Home: Future conversiojt to
COST permanent residence
(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 -q)-1 -360 _ 8L LI `i' -5F L ) 9 ( Z
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 bearing) ❑Public or Private •Number of Stories
ood Frame •Total square feet of floor area,
❑Individual (septic tank,etc.) all floors,based on exterior
❑Structural steel dimensions
❑Reinforced concrete TYPE OF WATER SUPPLY •
Total land area,sq.ft.
❑Other-Specify
Public or private company
NUMBER OF OFF-STREET
❑Individual (well,cistern) PARKING SPACES
Enclosed `1
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
�- El Gas Outdoors
❑Oil
^ RESIDENTIAL BUILDINGS ONLY
—`„`�1`J ❑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.
,. Al c-;r1 1n irk c,r 429GC. CPC)fc( '- t L Z i
Owner \�' J C J
t1
10 :2. - .94 l r)�(-,-v. . L: )) : E rn .can . c C. �7. 2
C°''Contractor State Lignse No.
3.
Architect
v
The owner of this building and the undersigned agree to conform to all applicable laws.
Signature of applicant Address Application date
,. . „....--a �.-- (2-/.,, -, ire/ C/ irif/c7a/v04),. OCo 08/88
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY 0\
,
JEF lit1 ,IDCAU HE DEPARTMENT.
APPROVED y9 V e® PERMIT FEE ISSUE DAT RECEIPT NUMBER
JUN g 1988 �, C a -
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