HomeMy WebLinkAboutBLD1987-003911 . BUILDING PERMIT AE"PLICATIOI '
Jefferson County Building Department• County Courthouse •Port Townsend,Wash.98368 • 385-1310
N E
I. LOCATION: geographic name S W SIDE OF ROAD FEET
NE
S W FROM INTERSECTION OF ROAD AND Qri,5 .--.ran ei ROAD
other specific location or landmark: (IP I f --7
LEGAL DESCRIPTION: 118 I-(� {(� 0 C v �`n�fC_Ce _
Park ,I/ Lot Block ;/ Subdivisi
l` I0 l.4 V3 ' q 8 Tax Number %Section Section ownship R1an Range
II.TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
New building Single Family El County Resident
❑ ddition ❑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
i1� OWNERSHIP ❑Full-time Residence
�� J El Private (individual,corporation,
nonprofit institution,etc.) El Second Home: Recreation Cabin,etc.
El Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: Ifa' --� ❑Second Home: Future conversion to
permanent residence
�1 COST (Omit cents)
Nonresidential- Describe in detail proposed use of buildings,e.g.,food
i • 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. •
J• a. Electrical If use of existing building is being changed,enter proposed use.
b. Plumbing 7Y II I n a)(. 8 l0, b ! l 1 •O
7 c. Heating,air conditioning foss I q,�Z t` U l� 1�5�L �l
d. Other (elevator,etc.) COOS _1 LI 0� j 3 �9 / 1 3� 1- O Co(�t?J \ tic3; ! 2- 1
• TOTAL COST OF IMPROVEMENT $ .' l 4.��! III.SELECTED CHARACTERISTICS OF BUILDING - fi q L' ) (pQ2--
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
❑Masonry (wall bearing) Public or Private '
•Number of Stories
•Total square feet of floor area,
Xood Frame ❑Individual (septic tank,etc.) all floors,based on exterior
tructural steel dimensions
TYPE OF WATER SUPPLY
❑Reinforced concrete )Kublic
•Total land area,sq.ft.
or private company
❑Other-Specify NUMBER OF OFF-STREET
❑Individual (well,cistern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
El Oil ', RESIDENTIAL BUILDINGS ONLY
Electricity , Number of bedrooms 1
..)El*
TYPE OF MECHANICAL
•
LiOther-Specify r Number of •
Full
bathrooms
Partial
IV. IDENTIFICATION- •
Name Mailing Address-Number,street,city and State ZIP code Tel.No.
• .oEert (90 h0J7 a I-i-� Ave. ( ) ��,=�, -�78_
Owner
moss Lynn rp� nr1 9 6n3(4) yof:�2.
L>o ( (~� C` nr\c,frr• PO, t3o�sc ao�� ri, 9f33ln.S �, ?-
P tractor State License o. .
cf l3..3
•
Architect
The o ner f this bu' ing n the undersigned agree to conform to all applicable laws.
itg of appl icon_ Address
f�rJ Application date
/n/OS/8()
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
AP ROV Y
/>/.A-• • G Sew�"
JE N COUNTY HEALTH DEPARTMENT
APPROVE BY• ( \ PERMIT FEE ISSUE DATE
` `n\✓1 //-- RECEIPT NUMBER
IV MD 4 4.,
07
c, N") 0 1-1 ( 1)
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