HomeMy WebLinkAboutBLD1987-00439 II I
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BUILDING PERMIT APPLICATION
Jefferson County Building Department• County Courthouse •Port Townsend, Wash.98368 • 385-1310
I. LOCATION: geographic name S W SIDE OF (y-..;.-7 / LI / ROAD FEET
NE
S W FROM INTERSECTION OF ROAD AND ROAD
other specific location or landmark: AA C-/3 (rZ„..- -PA � -- !2,7 0 73 (/0/j
LEGAL DESCRIPTION: t
Lot Block Subdivision�.+
Tax Number Y.Section Section Township Range
II.TYPE AND COST OF BUILDING
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
❑New 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
❑Hotel,Motel,Dormitory at either the U.S.Navy's Trident or
❑Repair,replacement number of units
Indian Island Facilities?
❑Wrecking ❑Mobile Home
❑Moving (relocation) ❑Other—Specify
❑YES 0iVO
❑Foundation only
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: l /,.; ❑Second Home: Future conversion to
;, : permanent residence
COST (Omitc nts)
"Nt'''' ,t�x .` Nonresidential— Describe in detail proposed use of buildings,e.g.,food
• Cost of improvement $ I 600 processing plant,machine shop,laundry building at hospital,elementary
To be installed but not included I school,secondary school,college,parochial school,parking garage for
in the above cost department store,rental office building,office building at industrial plant.
,k' a. Electrical If use of existing building is being changed,enter proposed use.
Al- b. Plumbing00 4 c. Heating,air conditioning V
^.°• , d. Other (elevator,etc I
• TOTAL COST OF IMPROVEMENT $
„. III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
r--l ❑ ❑ •Public or Private
Masonry (wall bearing) •Number of Stories i
Sod Frame •Total square feet of floor area,
[�-Individual (septic tank,etc.) all floors,based on exterior
❑Structural steel dimensions 500 —
❑Reinforced concrete TYPE OF WATER SUPPLY
•Total land area,sq.ft.
❑Other—Specify 0�Public or private company
IG ndividual (well,cistern) NUMBER OF OFF-STREET
PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE F F EPLACE
❑Gas i *aItI Outdoors
❑Oil ' .y/0Q CJ.� RESIDENTIAL BUILDINGS ONLY
electricity Number Number of bedrooms
❑Coal TYPE OF MECHANICAL
1 "-i {Full
)
Other— Specify (341 Cr��^ Number of
bathrooms
Partial
IV. IDENTIFICATION-
me Mailing Address[� —Number,street,city and State ZIP code Tel.No.o.
1. �, d-4"t- I �j /Y--4` 1.-e`s _. />�7 ._-` r Ll /lr b j j`t�I-�7y 1 `4�
Owner iqt �l p/`/ C L�C�.1 q.L^Z ��'� f `� �t ' 13-U l !' (h-c ,,J
2.
Contractor State License No.
3.
Architect
The owner'f th's building and the undersigned agree to conform to all applicable laws.
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N PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
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APPROVED BYiz
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JEFFE ON OUN Y HEALT DEPT
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I APPROV B : PERMIT, E� ISSUE DATE PERMIT NUMBER
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