HomeMy WebLinkAboutBLD1987-00027 • BUILDIN ERV T APPLICATION. '
Jefferson County Building Department• County Courthouse • Port Townserd, Wash.98368 • 385-1310
N E
I. LOCATION: geographic name S W SIDE OF ROAD FEET
NE COS W FROM INTERSECTION OF ROAD AND aD (_)r W r-per-3 ROAD
other specific location or landmark: P T
LEGAL DESCRIPTION:
3ox-c ^I Lot Block Subdivision
00 3 off' `3z 33 Township30 1CQ )
4- o Tax Number /a Section Section Range
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
number of units
Alteration 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
USE
OWNERSHIP
❑Full-time Residence
❑Private (individual,corporation,
nonprofit institution,etc.) ❑Second Home: Recreation Cabin,etc.
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: /0.3 ❑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 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 '"?3CJ (ii► 0R5 a-S 0
c. Heating,air conditioning
•
d. Other (elevator,etc.)
• TOTAL COST OF IMPROVEMENT $ #
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
ID Masonry (wall bearing) •Number of Stories
❑Public or Private •Total square feet of floor area,
Wood Frame ❑Individual (septic tank,etc.) all floors,based on exterior
❑Structural steel dimensions
TYPE OF WATER SUPPLY
❑Reinforced concrete ��'` •Total land area,sq.ft.
❑Other—Specify ,Public or private company
!!!/ NUMBER OF OFF-STREET
❑Individual (well,cistern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY 1.-1
ylectricity Number of bedrooms
/❑Coal TYPE OF MECHANICAL
Number of Full -� q4),
❑Other—Specify bathrooms
Partial
IV. IDENTIFICATION- •
Name Mailing Address—Number,street,city and State ZIP code Tel.No.
1. 1Q(-)n (JO i 18or1 a.C) For Cc rne rs R c(83G S -2351
Owner
2. ` e,
Contractor State License No.
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
ignatu of applicant t Address Application date
Y �/Y) cti.e . o . 8 ,
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY
10.__ICk \-A i 0 (0 ( 7 K)
JEFFE-, •N NTY HEALTH DEPARTMENT
APPROVE IV:` PERMIT FEE ISSUE DATE
_ RECEIPT NUMBER
•
cQ58 •
q
' 50 // ! 0 � �
8� l , GCS l
L-/
BUILDING OFFICIAL
a- 7 , 00 ,
• The Printery—Port Townsend
l �
.i r+. F rr.TR=aa c'-3-r C;c)t T NT P
Jefferson County Planning And nil i i n i nn Department
Courthouse , ,srn Floor
PO Box 1 2 2 0
Port Townsend . WA ynMnrs
208-3R5-:1 i 4 i
PERMIT # - BLD 1-11112% DATF. T SSi1FD. _ 1 0/0q/ i!
SITE ADDRESS : 520 FOUR CORNERS RD
: PORT TOWNSF.ND . WA 9R38.
OWNER • DON WTT,Si1N PHONE : 385- 35 1
iv1A T T,TN( A DR [ 5211 FOUR CORNERS RD
: PORT TOWNSFND WA -les. nm
CONTRACTOR . . _ NO CONTRACTOR PHONE
MATLTNC AD>>R -
CONTR . „T C #: FXPTRAT T llN DATE !
PARCEL NO. . . : 001 .S,'S4-OOq
LEGAL DF.SC . . : STR 33-30-O i WWM. TAX i#
LOT BLOCK
ilr,:1urct,p"riuN OF IMPROVEMENT : single family addition
Footing Setbacks (Shoreline Setback) /Mobile Home n i nck i nr!
C ) Foundation !
1 iinderarrnind Piumnina/tTncerarnund insulation !
i FramingriPlumning/Chimney
•
f j insulation !
; Sheetrock:
i Sewage Disposal System Final !
i Final /Occupancy Approval !
CALL 385-9 i 4 i 24 HOURS T N ADVANC;F. T"OI SCHEDULE T N:Irmt;"!TONS .
Office Hours q a . m. to 5 n. m.
inspector ' s Hours - in a .m.
24 Hour Recorder for inspections.
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