HomeMy WebLinkAboutBLD1988-00331 R JILDING PEHlvii i .-,1 , Lj ,,f-ki iON
Jefferson County Building Dep. nt• County Courthouse •Port Townsend, 1 98368 • 385-9141
N E
I. LOCATION: geographic name S W SIDE OF C/,^ `-ROAD FEET
S W FROM INTERSECTION OF ^ ,
ROAD AND - 1 lC-' ( f C pt1fe n IR d ROAD
other specific location or landmark: C/
LEGAL DESCRIPTION: / (-,N n.Q-i 5P
Parcel rcel Lot Block Subdivision
�`� �.�V , (c 5 Z9 /4/
Bo 1 ` '-� Tax Number Y4 Section Section Township Range
II.TYPE AND COST OF BUILDING-
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
New building El Single Family ❑New County Resident
!LJ Addition ❑Multi-Family Is this structure to serve the residential
number of units
❑Alteration or commercial needs of those employed
❑Hotel,Motel, Dormitory at either the U.S.Navy's Trident or
El Repair,replacement
number of units Indian Island Facilities?
❑Wrecking ❑Mobile Home
❑Moving (relocation) XOther—Specify
❑YES ❑NO
❑Foundation only
Cis�fr—fi� 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: . ❑Second Home: Future conversion to
vv permanent residence
COST I (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,ha enter proposed use.
b. Plumbing 9-1X b - 9 `t� ( a c3 R1-10
c. Heating,air conditioning
d. Other (elevator,etc.)
• TOTAL COST OF IMPROVEMENT $
III.SELECTED CHARACTERISTICS OF BUILDING -
0 PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
Cr ['Masonry (wall bearing) ❑Public or Privatt ; •Number of Stories
v )2Cliiicood •Total square feet of floor area,
Frame ' ,Q Individual septic tank etc.) all floors,based on exterior
❑Structural steel �i dimensions
-/ ❑Reinforced concrete TYPE OF WATER SUPPLY •Total land area,sq.ft.
❑Other—Specify E]Public or private company
E flndividua((well cistern) NUMBER OF OFF-STREET
[ f PARKING SPACES
T1CJ ' Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
LiGas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY
❑Electricit Number of bedrooms
TYPE OF MECHANICAL
❑ Number of Full
Other—Specify
bathrooms
Partial
IV. IDENTIFICATION - •
Name Mailing Address—Number,street,city and State ZIP code Tel.No.
. `--'/A)Li/1 Pr1C.'6- ► -- (C) , ut_)d 1 6 i�,r����rt I-i h 9 eA 1c2 c/
Owner
PCc(t9
2.
Contractor State License No.
3.
Architec
The ner of this building and the undersigned agree to conform to all applicable laws.
Si 4/re of ,Ii6((fa/
t\, Address Application date
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY// a(c�
JEFFERS COUNTY HEALTH DEPARTMENT
APPROVED B �PERMITFE I SUE DATE RECEIPT NUMBER
AP �� `
VE ® � .So l� �1707
BUILDING 1 ' L�r,\
`- 75ho e Printer Port Townsend /n
JEFFERSON COUNTY V I /Ss' F57/1/
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