HomeMy WebLinkAboutBLD1987-00410 110 BUILDING PERMIT APPLICATIO• .
Jefferson County Building Department• County Csurthouse •Port Townsend,Wash.98368 • 385-1310
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I. LOCATION: geographic name S W SIDE OF ROAD r i• FEET
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S W FROM INTERSECTION OF ROAD AND •i '41�-P ROAD
other specific location or landmark: ,
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EGAL DE R TION: �'"
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Lot Block Subd`rvisicn_
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Tax Number %Section Section Township � Range
II.TYPE AND COST OF BUILDING-
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY •
❑New building ❑Single Family ❑New County Resident
El Addition ❑Multi-Family Is this structure to serve the residential
number of units or commercial needs of those employed
❑Alteration " P Y
❑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) XOther—Specify ❑YES ONO
❑Foundation only
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uooc7 _ Y
USE
OWNERSHIP
❑Full-time Residence
❑Private (individual,corporation, • ❑Second Home: Recreation Cabin,etc.
nonprofit institution,etc.) /�
CI Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: l "—3 ❑Second Home: Future conversion to
permanent residence
S+ Jj 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
c. Heating,air conditioning
d. Other (elevator,etc.)
-. • TOTAL COST OF IMPROVEMENT $ !.
-7) III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
— _. Masonry (wall bearing) •Number of Stories
El ❑Public or Private •Total square feet of floor area,
❑Wood Frame ❑Individual (septic tank,etc.) all floors,based on exterior
ID Structural steel dimensions
❑Reinforced concrete TYPE OF WATER SUPPLY •Total land area,sq.ft.
❑Public or private company
El Other—Specify 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
❑Electricity • , Number of bedrooms
❑Coal TYPE OF MECHANICAL
Number of Full
❑Other—Specify r bathrooms
Partial
IV. IDENTIFICATION- •
Name Mailing Address—Number stre t,city and State ZIP code Tel.No.
1.
Owner 1~
o16�) P? (9p1(--/
2.
Contractor State License No.
. 3
Architect
The o gge�e of this building ap the undersigned agree to conform to all applicable laws.
o f appliX:' Addre Applicat. n date_
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PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY'
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JEFFE C N'TY H . TH DEPARTMENT
APPROV B : P- RMIZ FEE ISSUE DATE
RECEIPT NUMBER
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BUILDING OFF IAL N
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