HomeMy WebLinkAboutBLD1988-00342 0 UILDING PERMIT APPLICATION
Jefferson County Building Dtment• County Coqrthouse • Port Townsentsh.98368 • 385-9141
N E
I. LOCATION: geographic name S W SIDE OF f'� ROAD FEET
S W FROM INTERSECTION OF ROAD AND V l �, i f ROAD
other specific location or landmark: 1 m ?0 ( f ` 'Q- m v r' `C- R&C—__
LEGAI. DE0S3RIPTION:
PA V f`1 Lot Block c9\3 Sub_c_ i_07-1/0
c:::Qx.N....)
70 . .3 IC03 Tax Number %Section Section Township Range
II.TYPE AND COST OF BUILDING-
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
ew building ❑Single Family ❑New County Resident
❑Ad I 'on ❑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
❑Repair,replacement number of units ?
Indian Island Facilities.
v„} I El Wrecking Q bile Home
❑Moving (relocation) ❑Other—Specify ❑YES ❑NO
❑Foundation only
' USE
I OWNERSHIP
❑Full-time Residence
W ❑Private (individual,corporation,
nonprofit institution,etc.) Cl Second Home: Recreation Cabin,etc.
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: ❑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 1 ��TC)
c. Heating,air conditioning .P "' / < (O
d. Other (elevator,etc.)
• TOTAL COST OF IMPROVEMENT $
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWA.GF�9' DIMENSIONS
❑Masonry (wall bearing) CI Public or Priva •Number of Stories 1
•Total square feet of floor area,
El Wood Frame septic tank etc.) all floors,based on exterior
❑Structural steel dimensions
❑Reinforced concrete TYPE OF WATER SUPPLY •Total land area,sq.ft.
Other_Q Specify, r� (� ❑Publicvior private company
f Cl—Specify
-bL^1xvxl J.r NUMBER OF OFF-STREET
❑Individual (well,cistern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
RESIDENTIAL BUILDINGS ONLY
,...,Si?i.iil...._
ectricity Number of bedroomsCR
❑Coal TYPE OF MECHANICAL
❑Other—Specify
Number of Full
bathrooms
Partial
IV. IDENTIFICATION- •
Name Mailing Address—N tuber,street,cit and State ZIP code Tel.No.
i5
1/("6;
Owner �OAT
a 3 ) `�O
2. r )
Contractor State License,No.
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
4-lat f ap lic Add s `` Applica . ate
i/km.44.77
•. / —)
79"bni-Q----
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY
JEFFER-:•• COUNTY ALTH DEPARTMENT
APP1pPE• :. •+ PERMIT F ISSUE DATE RECEIPT NUMBER
r
FEB ' 1988 �i'_'____ c... ��
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BUILDI FICIAL
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pA` H SqN COUNTY
ELUti DE;T
P4e Printery—Port Townsend