HomeMy WebLinkAboutBLD1987-00429 B DING PERMIT APPLICATION .
Jefferson County Building Depat• County Cdurthouse • Port Townsend, 14 °8368 • 385-1310 "Ai `E
N E
I. LOCATION: geographic name S W SIDE OF ROAD FEET
N E LI ROAD
S W FROM INTERSECTION OF ROAD AND I 1�% C . / 1 11
other specific location or landmark: -
LEGAL E CRIPTION:
U re Lot Block Subdi
0„0_1 Tax Number %Section Section Township Range
II.TYPE AND COST OF BUILDING-
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
ew building ❑Single Family ❑New County Resident
❑Addition ❑Multi-Family Is this structure to serve the residential
number of units El Alteration or commercial needs of those employed
❑Hotel,Motel, Dormitory at either the US.Navy's Trident or
Repair,
❑ replacementnumber of units Indian Island Facilities?
❑Wrecking ❑l Mobile Home
❑Moving (relocation) 15 ther-Specify El YES ONO
❑Foundation only ✓`\
OWNERSHIP L- „e QA_) a Y,.
USE❑Full-time Residence
❑Private (individual,corporation,
nonprofit institution,etc.) ❑Second Home: Recreation Cabin,etc.
El Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP:." LI 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 chan ed,enter proposed use.
b. Plumbing ar)X q�.;bV 0 d, g 6‘ARD F
c. Heating,air conditioning ( '
d. Other (elevator,etc.)
-- • TOTAL COST OF IMPROVEMENT $
Cr, III.SELECTED CHARACTERISTICS OF BUILDING -
Zr-- •PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
E]Masonry (wall bearing) ❑Public or Private •Number of Stories
•Total square feet of floor area,
C od Frame ❑Individual (septic tank,etc.) all floors,based on exterior
El Structural steel dimensions
❑Reinforced concrete TYPE OF WATER SUPPLY •Total land area,sq.ft
El Public or private company q'
❑Other-Specify NUMBER OF OFF-STREET
❑Individual (well,cistern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
\./ ID Gas Outdoors
7`-T Clod RESIDENTIAL BUILDINGS ONLY !-
❑Electricity Number of bedrooms
TYPE OF MECHANICAL
❑Coal Full
❑Other-Specify Number of
bathrooms
Partial
J IV. IDENTIFICATION- •
-
Name Mailing Address-Number,street,city and State -, ZIP code---, Tel.No.
Qc.` 1. SCl'\f o k / Q Okiti /7.S /77 a /C/ ''5-: OLV
Owner /
2. _
Contractor State License No.
3-
Architect
The owner of this buildin and the undersigned agree to conform to all applicable laws.
Signature`of lican Address Application date
,(
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY -2 I WO 9 -C-1-3 7 .
JEFF C TH DEPARTMENT •
APPROVE B PERMIT FEE ISSUE DATE RECEIPT NUMBER
rFP r 87 / rS') 6.?— s —?7 vc ,: (., 07,,,Q
BUILDING OFFICIAL —51/43-g--
The Printery -Port Townsend 43 f 0
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