HomeMy WebLinkAboutBLD1988-00343I
BUILDING PERMIT APPLICATION
Jefferson County Building Depiint• County Courthouse • Port Townsend, till 98368 • 385-9141
N E
I. LOCATION: geographic name S W SIDE OF_ _ ROAD{ / FEET .
N E L/ / �/
S W FROM INTERSECTION OF ROAD AND ROAD
other specific location or landmark: 2i I 1 0 , J l 1
LEG,AL ��ES IPTION: CQ .
P� f a \/ �).. Block Subdivision
74)
Tax umber %.Section Section Township Range
II.TYPE AND COST OF BUILDING-
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
@w 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)
in Other—Specify ❑YES ❑NO
❑Foundation only
•
OWNERSHIPeA,Cial\,t) USE
❑Private (individual,corporation,
❑Full-time Residence
nonprofit institution,etc.) ❑Second Home: Recreation Cabin,etc.
144...1
❑Public (Federal,State or local ov't.)
9 UBC OCCUPANCY GROUP: El Second Home: Future conversion to
permanent residence
COST (Omit cents)
Nonresidential— Describe in detail proposed use of buildings,e.g.,food
• Cost of improvement $ r y
processing plant,machine shop,laundry building at hospital,elementary °‘ j
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 proposedpr use.
b. Plumbing 3O l(V /4'1 ,) /'1 _ y-ti j@. 9 /0 O a�
c. Heating,air conditioning /
d. Other (elevator,etc.) .,
• TOTAL COST OF IMPROVEMENT $
III.SELECTED CHARACTERISTICS OF BUILDING -
I PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
❑❑/Masonry (wall bearing) ❑Public or Private •Number of Stories
wood Frame •Total square feet of floor area,
IT ❑Individual (septje'tan�) all floors,based on exterior ,...
❑Structural steel dimensions _ — "
TYPE OF WATER SUPPLY
❑Reinforced concrete •Total land area,sq.ft. ... . --
❑Other—Specify ElPu lic or private company
NUMBER OF OFF-STREET
❑Individual (well,cistern) PARKING SPACES.%'
PRINCIPAL TYPE OF HEATING FUEL' Enclosed ,
y TYPE OF FIREPLACE
❑Gas Outdoors r.(
❑oil
,RESiDENTIAL BUILDINGS ONLY
❑Electricity f Number of bedrooms
❑Coal TYPE OF MECHANICAL /
❑O�t1�'er!—Specify - ' Number of Full
/
Partial
bathrooms
i
IV. IDENTIFICATION-
Name �`�Mailing Address—Number,r street,city and State ZIP code Tel. No.
1. ��W re, ,LJ) r i / 3 / V 9:3 c 7 7�P`J`
Owner ..,Ii\Cte`* -.r
3Q -
7`�f) � Cou
12 actor f' 1 i' State License No.
ViliAii
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
i n ture of ap lica I Address
C0 ppli lion da e
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
4,7ROVED BY
�
rP-- v tc w._
JEFF. "-." _'S'1-NTY HEA TH DEPARTMENT
4PPR•v"D D PERMIT E
lig
ISS E DATE REC3EIPT N9(ipUMBER
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