HomeMy WebLinkAboutBLD1987-00098 BUILDING PERMIT APPLICATI• •
Jefferson County Burg Department• County'ourthouse •Port Townsend,Wash.
98368 • 385-1310
N E
I. LOCATION: geographic name S W SIDE OF R AD
N E
S W FROM INTERSECTION OF ROAD AND t� � C ItOA T
other specific location or landmark: O Cr ill- /
1.
LEGAL DESCRIPTION: /,2J . / ti `' 1�;` O,(vvv� �111 � <1 (29L2i)
Lot Block /t` C rS/ubdivisi
C)o a / 0 3 a X -2,(A,)Tax Number /.Section Section Township Ran e
II.TYPE AND COST OF BUILDING- g
TYPE OF IMPROVEMENT BUILDING TYPE
MOBILIT •
Y
building XL,Single Family
��❑A``ddition ❑New County Resident
❑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)
❑Foundation only ❑Other—Specify [DYES ❑NO
OWNERSHIP USE
❑Private (individual,corporation, El Full-time Residence
•
nonprofit institution,etc.) 1::]Second Home: Recreation Cabin,etc.
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP:/s
❑Second Home: Future conversion to
COST permanent residence
(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 e,)isting building is being changed,enter proposed use.
b. Plumbing I(Y' c--d
c. Heating,air conditioning L
d. Other (elevator,etc.) ,�`A i Is—`^I ii• TOTAL COST OF IMPROVEMENT $ ' t
III.SELECTED CHARACTERISTICS OF BUILDING - S
3 0 cro
PRINCIPAL TYPE OF FRAME TYPE OF SEWA E DISPOSAL DIMENSIONS J o�
❑Masonry (wall bearing) '
❑Public or Private Number of Stories
� WQod Frame •Total square feet of floor area,
!v ❑Individual (septic tank,etc.) all floors,based on exterior
❑Structural steel dimensions
❑Reinforced concrete TYPE OF WATER SUPPLY 4,
❑Other—Specify private company •Total land area,sq.ft.
❑Public or 9p
r
NUMBER OF OFF-STREET❑Individual (well,cistern) \\
PARKING SPACES ��
PRINCIPAL TYPE OF HEATING FUEL Enclosed
TYPE OF FIREPLACE
❑Gas Outdoors
3
❑Oil
,t RESIDENTIAL BUILDINGS ONLY
❑Electricity i Number of bedrooms y=
❑Coal TYPE OF MECHANICAL
��3ether—Specify p Number of Full
LYm Ni' 't jQO bathrooms
1 Partial
IV. IDENTIFICATION- '
•
Name Mailing Address—Number,street,city and State
H0e,41
) /1 ��� e ZIP code Tel.No.
fOwner
�1 � 1{/ ��
' t,et� ( . — l° 220,c \S S S II\w• W A `183102
Contractor State License No. I
As-f4 PCIA-7a5
3
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Signature opplicant �� Address
fr /�'��n 0� kb)W----
Appli lion d to
��-�� 1 /c'/..,cam I I �(0�
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT
APPROVED BY [�,, �s 1 WATER DISTRICT
O 41 v`"'4 f` t l 2 t\nl Q,c l^^''..._
JEFFEWQE1 i ;NTY HEAL, DEPARTLIENT
APPR eD VY eI •t t RAT FEE ISSUE DATE
iiii - �, RECEIPT NUMBER
JANzz see 1 c ,�� -3 1 „.....--. as
BUILD WLgLN !S
Pr ntery—Port Townsend 771 (1 ! ��A
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