HomeMy WebLinkAboutBLD1988-00351 BUILDING PERMIT APPLICATION
Jefferson County Buildin•partment• County Courthouse • Port Town Wash.98368 • 385-9141
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I. LOCATION: geographic name S W SIDE OF ROAD FEET
NE
S W FROM INTERS TION OF ROAD AND � hh��ROAD
other specific location or landmar �� 7 (.1)1 / p �j �i//a�,2r G�—T1 ���y /L
LEGAL DESC�iIPTION: CC
I(�(�y-� rjt,1 Lot
(� 'C /
SuLvi g1 it l
Tax Number %Section Section Township Range
II. TYPE AND COST OF BUILDING-
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
❑New building Single Family ❑New County Resident
❑Addition 2❑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
i ❑Moving (relocation)
❑Other—Specify ❑YES ❑NO
❑Foundation only
NO P-FpPIn- E-K1ST1r— fiOA.lrkOc'llur* .
V OWNERSHIP
l USE
❑Private (individual,corporation,
❑Full-time Residence
nonprofit institution,etc.) ElSecond Home: Recreation Cabin,etc.
+.lo ❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP:g----3 ❑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 d artment store,rental office building,office building at industrial plant.
a. Electrical If use of existing building is being changed,enter proposed use.
� ,
.4 b. Plumbing .. �1--,
,� Epe-1 IL 1—OtJ. LO1Tta k
4:::Q c. Heating,air co ' toning
d. Ot elevator,etc.)
OTAL COST OF IMPROVEMENT $
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
❑Masonry •(wall bearing) •Number of Stories
❑Public or Private
❑Wood Frame •Total square feet of floor area,
❑Individual (septic to ,etc.) all floors,based on exterior
❑Structural steel dimensions
Reinforced concrete TYPE OF WATER S •PLY •Total land area,sq.ft. ... . ..
Other—Specify ❑Public or p vate company
NUMBER OF OFF-STREET
❑lndivid .1 (well,cistern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE 0' FIREPLACE
❑Gas Outdoors
❑Oil
RESIDEN •L BUILDINGS ONLY
❑Electric' Num••r of bedrooms
GI al TYPE OF MECHANICAL
Other—Specify Number of Full
bathrooms
Partial
IV. IDENTIFICATION -
Namer Mailing Address—Number,street,city and State ZIP code Tel.No.
1. LEE F/�z,, C �/3 /4th ,„ zip
Owner
Contractor2. ^��"W, a,t o a �� ., e V Ll a "— s
5 _� C
�, s9� P 1
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Sig rr e ofof applic nt Addres t %°i pcajti n date
J441-/-7
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY
/17.- - Otc i,....,.....
JEFFEFARI RJ - EEEL H DEPARTMENT
APPROVED BY: PERMIT FEE ISSUE DATE RECE I PT NUMBER
MA 1 , Z5 �9 „,,,e..,? ` chi
JEFFERSON COUNTY / ` /
BUILDING&PANNtDW\&GROG DEPT 2 t?,Sb
The Printery—Port Townsend