HomeMy WebLinkAboutBLD1987-00408 BUILDING PERMIT APPLICATION a '
Jefferson County Building epartment•• County Court.ouse ••Port Towns Wash.98368 •• 385-1310
N E
I. LOCATION: geographic name S W SIDE OF ROAD t ( -� FEET
S W FROM INTERSECTION OF ROAD AND cis ( 1 1 ` A ' 1 I I�(e, ROAD
other specific location or landmark:
LEGAL DESCRIPTION: o______,
�� 1(Lot Block 1 (..),Le s ? /� � Su ivi ' n
j Tax Number %SectionSection _i_k)
��0! Town ip Range
II.TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
4ew 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 ElHotel,Motel, Dormitory at either the U.S.Navy's Trident or
number of units Indian Island Facilities?
❑Wrecking `►' obile Home •
❑Moving (relocation) -ether—Specify ❑YES ❑NO
' ❑Foundation only 1
‘&ac—/in 404
OWNERSHIP USE
❑Full-time Residence
❑Private (individual,corporation,
nonprofit institution,etc.) ❑Second Home: Recreation Cabin,etc.
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP:f2<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 pro-osed use.
i r
b. Plumbing _-164__ % — 0 S 0 i 0` ((PO ir
c. Heating,air conditioning r`T e" - (�
''' d. Other (elevator,etc.) 'A A� . e j� i�y ��l
• TOTAL COST OF IMPROVEMENT $ N
III.SELECTED CHARACTERISTICS OF BUILDING - \ \ \ %
PRINCIPAL TYPE OF FRAME ,�� 5 C •
� DIMENSIONS
✓_� TYPE OF SEWAGE� OS •Number of Stories
❑Masonry (wall bearing) i=271 ublic or I5rivate `�`` ` Wood Frame •Total square feet of floor area,❑ ndivid al (septic tan ,etc.) all floors,based on exterior
❑Structural steel --: dimensions
TYPE OF WATER SUPPLY
Reinforced concrete •Total land area,sq.ft.
(l �
er—Spec' ❑Public or p ompany f
NUMBER OF OFF-STREET
lakv�(l � Individ al (well stern) PARKING SPACES
��, ""��� Enclosed
PRINCJ,PAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
Gas Outdoors
❑Oil '+ RESIDENTIAL BUILDINGS ONLY
❑Electricity , Number of bedrooms
❑Coal TYPE OF MECHANICAL
❑Other—Specify F Number of Full
bathrooms \ /
• Partial
IV. IDENTIFICATION - • •
Name Mailing Address—Number,street,city and State ZIP code Tel.No.
1. War- f� � ,3 q 7 W
Owner orl:r� of
2. "-�P
Contractor State License No.
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
--)
ignature of applicant Adds Applickion da
Nx.
(-141 ___ AS- P.rv \:IQ)
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PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY
W n C 1 CI /02IM
JEFFERS° COUNTY HEAL DEPARTMEN
APPROWp :R D pERMyT rE ISSUE DATE RECEIPT NUMBER
7,? .' ____7---.„\ ,.', - ra,,,N
BUILDING OQFFICIAL
AfFENSON '+LINTY ']'" / I /
PtANMINf, .,;i(pan/Tl F) 1 ll� ` j //( t /b'! c?
e r' tery—Port Townsend
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=463 ' — 6/7. 50'
700, . 13 /7 50'
203 Port Townsend , Washington . .983
SURVEYED FOR, n 8.. F..`.-SAMMANN � `'
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APPROVED
DEC 7 SV
JEFFERSON COUNTY
PIANOS SIM OW
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