HomeMy WebLinkAboutBLD1987-00420 BUILDING PERMIT APPLICATION•
Jefferson County Building'Department• County Courthouse •Port Townsend, Wash.98368 • 385-1310
N E
I. LOCATION: geographic name S W SIDE OF ROAD FEET
N E '
S W FROM INTERSECTION OF ROAD AND y, � �t (�� / L" OAD
other specific location or landmark: )!CUM i SSeAl- ICJ`) 1 •
LEGAL DESCRIPTION: U
/u Lot Block Subdivision
- yo/ 1/3 Oas• /I a /
Tax Number Ya Section Section Township Range
II.TYPE AND COST OF BUILDING-
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY •
❑New building )single Family ❑New County Resident 1\f 0
❑Addition /❑`Multi-Family Is this structure to serve the residential
number of units
LI 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
OWNERSHIP Full-time Residence
❑Private (individual,corporation,
nonprofit institution,etc.) ❑Second Home: Recreation Cabin,etc.
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP:/-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 s hool,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 /Y-'7 1 G'/�yf1 � j1 /L�
c. Heating,air conditioning (
d. Other (elevator,etc.) /`
‹.2) • TOTAL COST OF IMPROVEMENT $ I,
(-\`•1 III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
❑Masonry (wall bearing) ❑Public or Private •Number of Stories
•Total square feet of floor area,
❑Wood Frame 7, ``Individual (septic tank,etc.) all floors,based on exterior /�
❑Structural steel // dimensions �� x ��{
❑Reinforced concrete TYPE OF WATER SUPPLY GI__ 1
•Total land area,sq.ft. I ac r�
other-Specify Public or private company
NUMBER OF OFF-STREET
'" ❑Individual (well,cistern) PARKING SPACES
Enclosed
N
/ft--
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
Dui ,, RESIDENTIAL BUILDINGS ONLY
electricity . Number of bedrooms
❑Coal TYPE OF MECHANICAL
CI Other-Specify Number of {Full
bathrooms
• Partial CD
IV. IDENTIFICATION- . •
•
Name Mailing Address-Number,street,city and State ZIP code Tel.No.
•
1.
fe,beccA_ L oernd n '- O - ` bx 1154 1---,,at oc 61539 es
Owner d2../z,sse// 3.25 Z
2.
Contractor State License No.
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Signature of applican Address
�` A plica • n date
-? ci--,c(tyai
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1 PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY• 0g F of 7 J Iq(C 1
JEFFERSON COUNTY HEALTH DEPARTMEENT I
'PROVED BY: PERMIT FEE ISSUED TE RECEIPT NUMBER
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