HomeMy WebLinkAboutBLD1987-00349 BUILDING PERMIT APPLICATION •
Jefferson County Build,, Department• County Courthouse •Port Tow end, Wash.98368 • 385-1310
1.
N E
I. LOCATION: geographic name S W SIDE OF ROAD rr FEET
N E
S W FROM INTERSECTION OF ROAD AND_JC1 0 :), c-"�-., % V'- 7 ROAD
other specific location or landmark: \
E L C'R PTI
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V�
Lcil Block � Subdivision
1
At -2,19-452210,4Z Tax Nwill-7— %A Section Section T� ownship Flange
II.T E AND COST OF BUILDING -
I
TY OF IMPROVEMENT BUILDING TYPE MOBILITY
N ❑New building 0 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
❑Hotel,Motel, Dormitory at either the U.S.Nav
❑Repair,replacement number of units V's Trident or
❑Wrecking Indian Island Facilities?
._ ❑Mobile Home
❑Moving (relocation)
Other—Specify ❑YES ONO
4v\ ❑Foundation only
t. C\jk \� ' 'CO USE�
OWNERSHIP J �-/,kl'-'
❑Private (individual,corporation,
❑Full-time Residence
nonprofit institution,etc.) ❑Second Home: Recreation Cabin,etc.
❑Public (Federal,State or local ov't.)
9 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
c. Heating,air conditioning
d. Other (elevator,etc.)
• TOTAL COST OF IMPROVEMENT $ l
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
cC) ❑Masonry (wall bearing) ❑Public or Private •Number of Stories
❑Wood Frame ••Total square feet of floor area,
❑Individual (septic tank,etc.) all floors,based on exterior
❑Structural steel dimensions
TYPE OF WATER SUPPLY
❑Reinforced 'Total land area,sq.ft.
go+rcrete
❑Public or private company ,
❑Oth3—Specify
NUMBER OF OFF-STREET
-,-' ❑Individual (well,ci;tern) PARKING SPACES
-
r PRINCIPAL TYPE OF HEATING FUEL Enclosed
OF F/REPLACE
~"' TYPE .
❑Gas Outdoors '
...-- ❑Oil '' RESIDENTIAL BUILDINGS ONLY
❑Electricity i Number of bedrooms
CI Coal TYPE OF MECHANICAL
❑Other—Spe rfy ,, Number of Full
- bathrooms
Partial
—'- IV. IDENTIFICATION- "
•
NameJ Mailing Address— umber,street,city and State ZIP code Tel.No.
1. ! (�� 9 ( ,-(3.., (.1) �i� -7fRZC )
Owner }
LI)C--C---e-C
2.
Contractor State License No.
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
!Sf --k .1 o1 a 5b" \ ess /� D PaDf_
— Applir,�tio date �i
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY A/
/ y /1+--,)`-e--No'--
JEFFERSD C HEALTH DEPARTMENT
APPROVED B ' PERMIT F —1 ISSUE DATE RECEIPT NUMBER
, DI7( 7 3 D
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BUILDING OFFICIAL r
The Printery—Port Townsend
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