HomeMy WebLinkAboutBLD1988-00336 BLDING PERMIT APPLICATION
Jefferson County Building Depar nt• County Courthouse •Port Townsend, 14'98368 • 385-9141
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I. LOCATION: geographic name S W SIDE OF ROAD
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FF FEET
)<S W FROM INTERSECTION OF ROAD AND 2 l /Y J O (.I ROAD
other specific location or landmark:
LEGALDESCRIPTION: / a .
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n _ Lot Block Subdivisiop
X (Po/33 yo 1 j 7 2 C%R j/ (k...)
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rTax Nu Number 'ASection ecuon 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
number of units
❑Alteration 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) DX/Other—Specify ❑YES ❑NO
❑Foundation only l'.7)1 ale c '_X_
USE
OWNERSHIP ❑Full-time Residence
'ol ❑Private (individual,corporation,
nonprofit institution,etc.) 2 El Second Home: Recreation Cabin,etc.
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP:f=� ❑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- ing changed,enter proposed use. /
b. Plumbing S -7176) _ , r V
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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) •Number of Stories
❑ 9 ❑Public or Private •Total square feet of floor area,
"' Wood Frame ` ; d
Individual (septic tank,etc.) all floors,based on exterior p�
❑Structural steel �, dimensions 4 O dsr_
TYPE OF WATER SUPPLY
❑Reinforced concrete •Total land area,sq.ft. p p
❑Other—Specify Public or private company Z p D yrr-
❑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 0 0
❑Coal TYPE OF MECHANICAL
Number of Full
❑Other—Specify
\ / bathrooms
/l1 Partial /
IV. IDENTIFICATION -
Name Mailing Address— Number,street,city and State ZIP code Tel.No.
1. '\(�� l q e r a Pr r,.t,k) 0\ . 1'O S
s3-9y7`
Owner xU
5A—e-4.4-\-,()/1/— jC,t., ,1 )-4(Y1 a\, . ton
2.
Contractor State License No.
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3.
Architect --- `— v —'--—
The owner of this building and the undersigned agree to conform to all applicable laws. •
Signature of a licant Address t , Application date
C /547 4-ra ee-,e-dr C coXi9fa(X -z
PLANNING AREA FIRE DISTRICT SCHOO DISTRICT WATER DISTRICT
APPROVED BY ' ) / 0 ,�\�'� 7 / /C_�,
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JE Avg? WYIESDHEALTH DEPARTjM T
APPROVE BY: / RMITFEE ISSUE DATE RECEIPT NUMBER
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