HomeMy WebLinkAboutBLD1987-00363 BUILDING PERMIT APPLICATION '
Jefferson County Buildil epartment• Co sty Courthouse •Port Town Wash.98368 • 385-1310
N E '
I. LOCATION: geographic name SW SIDE OF �j ROAD FEET
S W FROM INTERSECTION OF ROAD AND /✓(") (6 . / ?A C`GJ.(./'9 ROAD
other specific location or landmark: `\--- `�, .a
LEGAL DESC PTION: 5 l ! /
P(4(2 J Lot B c Suu !on j 0
R..4, t '5e 1 Tax Number '%Section ection Township Range
II.TYPE AND COST OF BUILDING -
\ �- TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
❑D New building Single Family ❑New County Resident
4 �yQddition ❑Multi-Family Is this structure to serve the residential
�� number of units
❑Alteration or commercial needs of those employed
❑Hotel,Motel, Dormitory at either the U.S.Navy's Trident or
❑Repair,replacement number of units
Indian Island Facilities?
❑Wrecking ❑Mobile Home
❑Moving (relocation)
❑Other—Specify ❑YES LINO
❑Foundation only
OWNERSHIP Po l (0�/tl( \ USE
CI Full-time Residence
❑Private (individual,corporation, u�� tr
nonprofit institution,etc.) G 1".� ❑Second Home: Recreation Cabin,etc.
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: , Cl 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
\ • 1 in the above cost department store,rental office building,office building at industrial plant.
a. Electrical If use of existing building is being changed,ed enter proposed use
b. Plumbing //e/1( /(0 ` a('7 l- / _ ,j 5 CAL/
c. Heating,air conditioning
d. Other (elevator,etc.) /C4fr — r j-G�y
• TOTAL COST OF IMPROVEMENT $ ( ( v 1 ' 7`Q '-/il
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
El (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
LI 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 '
El Gas Outdoors
❑Oil '' RESIDENTIAL BUILDINGS ONLY
CI Electricity • i Number of bedrooms
CI Coal .' TYPE OF MECHANICAL
Number of Full
❑Oyfrbr—Specify
F bathrooms
/� Partial
W. IDENTIFICATION• A- 1,f� C ' r)-
Name Mailing Address—Number,street,city and State ZIP code ,;`Tel.No.
1. Nr.)NA) '14-(A.,— cii.LS
Owner rH
2.
Contractor \� State License No.
{
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Signature of applicant // "2(_e_ e
AddressR91�n,�%tiL !/l 1/(. vTv '5 // a
Appl�icyati n date�'��!�� } , -- G �. ' (Nt— /0 I if/ 'il r
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY
P- (c......>,, .,..v - t 451
JEFFERS° COUNTY HEALTH DEPARTMENT
APPROVED B : PERMIT FEE ISSUE DAT RECEIPT NUMBER
3 . IIIas
- 3
BUILDING OFFICIAL I L\ 3(.--)Y
1 • The Printery—Port Townsend
.) . ' �� ' IIIiII1iHiiOhIiI1HIIIIIIIIlIHIIIblulIhi� i lYlo
mimummilommoolmono
II 8 mu u
' NE , - ' i ENIMEMPAIMME lipliqlsolu
IMMO , imonnommolompolimmo
ummungo
111110111011 INEMEMPAllashml
pm:: no popmimpd :
erabliffitig
9 MINIM L• , NOMENCIMMIN 1 o lost
in
mow
ummonom mom
8
11111111
illlllllflhllolllllllllhlllllllllfflollhllllllllhonhljiiimiiiiii UhilIllIll.
5 IMMININEENIMPIAINEEM EMI
c , IMMENNEIROMPPF__:: II M 111101111V
INIMEllingli ' ' 1 I ' ' ' IN ' I 11111 IMMO
8 PINSEEMOVIIMMIN MIUMOINIME -
AMMININ-1 ' ' , I NNE , , 11111101111011111
IIiIlhIhIl01h1111ih1h1I1
01111110111.111•011 , " H ' i " MORMENHEI
simmomismiliminninimilimmillIPIEN
;. 1 2 3 iv 5 6 • .8 '
Iso feet
1 S Sta.:1:,k.,a,trAvo,k , a
62 ,
- 4- -1-1-7-c.1. /k-/Urc4-42. ')(
4?(.4%-tAg4C 63 r tA.. Ct i.•-•-i) LI"‘ '''' ( N•s% t *t) 1,C"-1<-
1 0/3 1 C697 *Q.S.-et,-‘_, "---. R_jZi( u -'./ IL'' '''
1 1 12erA 1 faIt14)C4- e'elfiL 3 47a 9° ' -CD 8(0021
Ilic,\Iqct
ot...x. ,
P,I I IS . ef2A-vi.)-4-)0J2_ 6,49-‘,trricibi4--
,
(-71L1h31 ILL) f_.,29,(A,. !,,k) pi4,10,06,d_ ( 70,0„ fatzu_t2i4s ,
( cts:3a
otc, __51c1,,,_fro/t—
okc,--rt,
/re *ANA-le-v.-- t4.,INNO4J1-
h ?M s- & A It 1)
A-1716? — mag,,,,, _
rpainetil,> H NA 2_,