HomeMy WebLinkAboutBLD1987-00437 10 BUILDING PERMIT APPLICATION. '
Jefferson County Building Department• Co„r!y Courthouse •Port Townsend, Wash.98368 • 385-1310
N E
I. LOCATION: geographic name S W SIDE OF Q ROAD / / FEET
2
S W FROM INTERSECTION OF ROAD AND l / v (/ / Of ROAD
other specific location or landmark:
LE AL DESCRIPTION:
,/,J r�� _ Lot Block \ � Su ivinJ
` ! D� v Tax Number /V,`/Y.�Section Section Township Range
II.TYPE AND COST OF BUILDING-
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
I ❑New building 0 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
v�( I} ❑Repair,replacement ❑Hotel,Motel, Dormitory at either the U.S.Navy's Trident or
9 v •
1 ❑Wrecking number of units Indian Island Facilities?
•�❑—Mobile Home
❑Moving (relocation)
AlAther—Specify ❑YES ❑NO
❑Foundation only
O0
USE
OWNERSHIP
❑Full-time Residence
❑Private (individual,corporation, ❑Second Home: Recreation Cabin,etc.
nonprofit institution,etc.)
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: --• El 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 proposed use.
''' b. Plumbing
cN("- c. Heating,air conditioning
d. Other (elevator,etc.)
• TOTAL COST OF IMPROVEMENT $ 1.
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
El Masonry (wall bearing) ❑Public or Private
•Number of Stories
(� •Total square feet of floor area,
C/ ❑Wood Frame ❑Individual (septic tank,etc.) all floors,based on exterior
❑Structural steel dimensions
❑Reinforced concrete TYPE OF WATER SUPPLY •Total land area,sq.ft.
❑Public 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
❑Oil RESIDENTIAL BUILDINGS ONLY
❑Electricity , Number of bedrooms
❑Coal TYPE OF MECHANICAL
Number of {Full
Pe_[be * bathrooms
V Partial
IV. IDENTIFICATION- •
Name Mailing Address—Number,street,city and State ZIP code Tel.No.
1. c).,,,_1(..,AP •0 .e iaw 93aa 7%-
Owner /V 5 ,R 1 C` , �e/D0
2. U� NN
Contractor State License No.
. 3
Architect
The • : of this building and the undersigned agree to conform to all applicable laws.
Si' azure •f applicant Addr A lic tr..?
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,NING
ARE DISTRICT SCHOOL DISTRICT WATER DISTRICT
OVED BY
JEFFERON COUNTY HEALTH DEPARTMENT
APPROVED 81^. �PMYT,�jj-E� ISSUE DATE
/ ) RECEIPT NUMBER
BUILDING OFFICIAL ___---3
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