HomeMy WebLinkAboutBLD1987-00021 N L
I. LOCATION: geographic name S W SIDE OF414 ROAD / FEET
N E I_ ab (2 ROAD
S W FROM INTERSECTION OF _ ROAD AND
other specific location or landmark:
1 ,i D SCR.
I Jc IPTION: Subdivision
`� Lot Block
'D I c, gS D Get 2/6'.c&S' Q
Tax Number Y.Section Section Township • Range
II.TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE PUBLIC APPROVAL
building Single Family
❑Addition ❑Multi-Family
ROad number of units Access Permit No.
❑Alteration
❑Hotel,Motel,Dormitory Utility Permit No.
Repair,replacement number of units
0 Wrecking 0 Mobile Home Emergency Services No.
0 Moving(relocation) ❑Other—Specify Street Width A:
❑Foundation only
EL E:critoip— f=y '9 B:
o --- Z (1_) . Additional Permits Required:
OWNERSHIP
Private(individual,corporation,
nonprofit institution,etc.) �,3
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP:
COST (Omit centsl 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 exiliting building is being changed,enter proposed use. 1
b. Plumbing CL,(/V\...., _ C) 3 -- cR 76-/c
c Heating,air conditioning J _ "' (o 7
d. Other(elevator,etc.) ` ' /.5 — 1 C 0
• TOTAL COST OF IMPROVEMENTS 3 `7
•
III.SELECTED CHARACTERISTICS OF BUILDING - r�
i
DIMENSIONS
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DIS L •Number of Stories
0 Masonry(wall bearing) ❑Public or Pri \ •Total square feet of floor area, e
Wood Frame Individual ptic tank, tc.) all floors,based on exterior '
dimensions 1�
truttural steel ti;,
TYPE OF WATER SUPPLY •Total land area,sq.ft r
Reinforced concrete CJ[
[]Public or • *Total
n •
Other—Specify n7< MBER OF OFF-STREET ;
ndivid cistern) PARKING SPACES
Enclosed
IIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE Outdoors
V Gas
❑Oil RESIDENTIAL BUILDINGS ONLY
Number of bedrooms •
❑Electricity TYPE OF MECHANICAL
❑Coal Number of Full P
y1 �_Q t11,� bathrooms Partial
I
v
IV. IDENTIFICATION - t
Name Mailing Address—Number,street,city and State ZIP code Tel.No.
'1-.1-1 S l - L-,r a. ,S .11A-i kcal l_ O o `«16 g -e, `'
t. • uPy Qrapo,..� -
Owner '
Z. • ,t,(_-- .
State License No.
Contractor
f-
3.
Architect ' ..
The owner of this building and the undersigned agree to conform to all applicable laws.
ç1Zddress
iAppl -room 4 data
///66\ -----
PLANNING AREA F RE DISTRICT SCHOOL DISTRICT WATER DISTRICT 1-
APPROVED BY \� � 6 I �� APPROVED 3Y APPROVED BY
0S 1 QELINE DEPT. PLANNING DEPT.
f-�AL DEt'� MHO —
PPROVJEFFE 9BY PERMIT FEE ISSUE DATE RD=1rr MJMBER
j .
APPROVECjBY: ��1.Qe,t,Mi<Fr 2'1 f
Sa nt�.n. , II s—,t �s �/
Is-- I
BUILDING \ \J��Qcc,.y.�ia� Z5� b'
Aso C
The P,.ntr - Port To.+Trend 6 - _ _
0�`agS t=Cc I 0 Q= r-0
Y)
• R .� ,_
.1"Fr.F' -F 37\1- i;iCTT TNTM ' iT s T.)i Tv� �r �cNI i m
`
Jefferson County Planning and Ru i i ci i nc- 'Department
Courthouse, Srd Floor
Pi) Box 1 220
Port Townsend, WA 9R3BR
206-3R5-91 4 i
PFRMTT # • RT,IlR7-0i)2 i 'JA T F. T SSIIFT). 09/03/R7
S T TF. AIlI1RFSS - 270R ilAtSOR RIl
! QU T,CRNt'., WA Y1tr.- Ir)
OWNRR •RAY DUPONT
PHt)Pvr. - 242-1554
MA T T,T IN( AI)I)R - 1 445 1 59TH AVF S
- TIJIcw I T,A WA yR 1 r6R
CONTRA%Ti1R . . - NO CONTRACTOR PHONE :
MATLTNG AI)I)K
CONTR . I,T C #- FXPTRATTON DATE!
PARcCF.T, NO. . . - RO i 2RS-ooq
F.CAT, I)F.SC . . - STK 2R-2R-01 WWM, TAX #
LOT , BLOCK
IIFSCRTPTTON OF TMPROVFiviF.NT! single family residence
1 r+ont i ncr/Setharks (Shoreline Seihack) /Mnh i l e Rome R i nck i nn-
( Foundation !
1 Underground Piumhinr /tinder;rround 'Insulat-ion -
i Framinnr,Piumnincr Chimney: /l'G7 @� Z
FOAM- / P L U diC j s , c�C 0
`71/ /f, ole-
0/c 44,61.
Sewane Disposal
System Final:
7, ; n 0 it< Setr) clicti
CALL 385-9 1 4 i 24 HOURS TN ADVANCF TO Siiiri)iiT,r, T N:11-,mc: I i c)NS .
Office Hours 9 a .m. to 5 n.m.
inspector ' s Hours 9i - 1O a . m.
24 Hour Recorder for Tnsnec.tions.