HomeMy WebLinkAboutBLD1988-00349 BUILDING PERMIT APPLICATION
Jefferson County Building DepSent• County Courthouse • Port Townsend, a 98368 • 385-9141
N E
I. LOCATION: geographic name S W SIDE OF ROAD FEET
N E 1 f V l Q(/ (�of r '4 (� ) L' )
S W FROM INTERSECTION OF ROAD AND �� ROAD
1.
other specific location or landmark: (
LEGAL DESCRIPTION:
` Lot ' Block Subdivision
' •��� ' / I 1
Tax Number 14 Section Section `township Range
9
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
❑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 LINO
❑Foundation only
Ci vit Cf-tr pC>(f
OWNERSHIP USE
❑Private (individual,corporation,
❑Full-time Residence
nonprofit institution,etc.) 2 r ❑Second Home: Recreation Cabin,etc.
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP:P-3 �""i ❑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 J� ,, ' 175 ) RI -I
c. Heating,air conditioning 1--T )/-, Cyr c psi( ( - / I (r `t E) -
d. Other (elevator,etc.) CX( `y e�
• TOTAL COST OF IMPROVEMENT $ Q
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
❑Masonry (wall bearing) ❑Public or Private •Number of Stories
El Wood Frame •Total square feet of floor area,
Individual(septic tank etc.) all floors,based on exterior
❑Structural steel '''������ \ dimensions
TYPE OF WATER SUPPLY Total land area,sq.ft.
O.Reinforced concrete •
Other—Specify �❑Public or priv to company (�
`ma,u , t'AC (IndividuaHwell,,cistern) NUMBER OF OFF-STREET e��X��
PARKING SPACES �,0c�
PRINCIPAL TYPE OF HEATING FUEL Enclosed (^�.>
TYPE OF FIREPLACE
�J
❑Gas Outdoors
""+�
❑Oil
RESIDENTIAL BUILDINGS ONLY 'r
Electricity Number of bedrooms .y
❑Coal TYPE OF MECHANICAL
Full
❑Other—Specify Number of j
bathrooms
Partial
IV. IDENTIFICATION -
Name Mailing Address— Number,street,city and State ZIP code Tel.No.
1. ���mPsCa ,
Owner 1 C� 1 /V� `t u�)
T4 der 291�
2.
Contractor State License No.
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Si ature of applicant Address Application date
4\2/N C iC .r I 'f 6.4A .2 0.4 -9..... f`- 1 i., ,
PLANNING AREA FI E DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY 71 .
‘-- esa,......."\--\-- 1.t_Q...------,572—...\\(,.\. a.,
JEFFER N C HEAL T DEPARTMENT
APPROVE 0 PERMIT FEE ISS E DATE
�r RECEIPT NUMBER
AI,.] t 88 3, 5.0 /2( a q(9 COQ
3UILDING OFFICIAL ���� r
JEI-FEIISON COUNTY e e. 50
PIAtifvum a BLUG DEPT (sca ,�,/� -
7
iintery—Port Townsend —' `/// --