HomeMy WebLinkAboutBLD1988-00347 BUILDING PERMIT APPLICATION
Jefferson County Building De vent• County Courthouse •Port Townsend,Ih.98368 • 385-9141
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,I. LOCATION: geographic name S W SIDE OF ROAD FEET
NE �f / f�
S W FROM INTERSECTION OF \\ ROAD AND [
C� I ( hi.�Y l 0 ROAD
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other specific location or landmark: �' ..�l ` r,,V11,VS-� ( / `
LEGAL DESCRIPTION:
PP1- 1)_ Lot Block Subdiv' ' no
53Q,a( Ol3U?
Tax Number Y.Section Section Township Ra ge
II.TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDINGU TYPE MOBILITY
❑New building tcl Single Family ❑New County Resident
❑Addition V❑l 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)
❑Other—Specify ❑YES ❑NO
❑Foundation only
�O /Re..�
- 0 � �� USE
OWNERSHIP ."-
Li r .�}� ❑Full-time Residence
[� ❑Private (individual,corporation, "��V �( �d
L"` ❑Second Home: Recreation Cabin,etc.
nonprofit institution,etc.)
W ElPublic (Federal,State or local gov't.) UBC OCCUPANCY GROUP: i,- ❑Second Home: Future conversion to
permanent residence
� COST (Omit cents) Nonresidential— Describe in detail proposed use of buildings,e.g.,food
`' k • 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.
e• a. Electrical If use of existing building is being changed,enter proposed use.
b. Plumbing
c. Heating,air conditioning
d. Other (elevator,etc.)
• TOTAL COST OF IMPROVEMENT $ 9 03
/Q III.SELECTED CHARACTERISTICS OF BUILDING - e- 1
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGEPOSA , DIMENSIONS
--,. ❑Masonry (wall bearing) ❑Public or Private 7 •Number of Stories -
CQ •Total square feet of floor area,
Wood Frame Individual ( ptic tank,et �.) all floors,based on exterior
tructural steel / dimensions
TYPE OF WATER SUPPLY
❑Reinforced concrete •Total land area,sq.ft.
❑Public or or. e company
❑Other—Specify NUMBER OF OFF-STREET
iodividu (well, istern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
Pt Oil RESIDENTIAL BUILDINGS ONLY '
IN lectricity Number of bedrooms eXt`. /1tQ.—
❑Coal TYPE OF MECHANICAL 1 '
❑Other—Specify
Number of Full �oN
bathrooms
Partial
IV. IDENTIFICATION-
Name Mailing Address—Number,street,city and State ZIP code Tel.No.
f. 11\PrQ.K QL. a 10 9'4 ( / Y l )) 9Z3 7ep 76,3 —
Owner
2. lJ l 1J Y \ (g.9 aPil d) — ic
Contractor State License No.
3.
Architect
T
he owner of this building and the undersigned agree to conform to all applicable laws.
Address Applic�iond to
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
/
APPROVED BY '
JEFFERS° C UNTY HEALTH DEPARTMENT
APPiippEp ERMIT FEE ISSUE DATE.,._ RECEIPT NUMBER
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The Printery—Port Townsend
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