HomeMy WebLinkAboutBLD1987-00446 411) BUILDING PERMIT A'PLICATIONii '
Jefferson County Building Department• County Courthouse •Port Townsend, Wash.98368 • 385-1310
N E
I. LOCATION: geographic name S W SIDE OF ROAD FEET
NE
S W FROM INTERSECTION OF da
AADAND, D y
other specific location or landmark: CILL
LEGAL ES RIPTION: c;2. ED-]
Lot Block Subdivision
~-, S , 0&) l t.,t)
00(05101,4' it Tax Number '/,,Section Section Township Range
II.TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
flew building ❑Single Family ❑New County Resident
❑Addition ❑Multi-Family
Is this structure to serve the residential
❑Alteration number of units 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 ONO
❑Foundation only
-06-*Ctid"ZJ41
USE
OWNERSHIP ea ra� ❑Full-time Residence
❑Private (individual,corporation,
nonprofit institution,etc.) ❑Second Home: Recreation Cabin,etc.
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP/ 1I.� — ❑Second Home: Future conversion to
permanent residence
COST (Omit cents)
Nonresidential— Describe in detail proposed use of buildings,e.g.,food
t,,. • 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 Q /,
/ V
changed,/� enter proposed use.
b. Plumbing .d x /S3 o = !3 O -- L D 5
. l a / h
c. Heating,air conditioning
d. Other (elevator,etc.►
./: • TOTAL COST OF IMPROVEMENT $ i.
III.SELECTED CHARACTERISTICS OF BUILDING -
.
C:1 DIMENSIONS I PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL
Masonry (wall bearing) •Number of Stories
❑ ❑Public or Private •Total square feet of floor area,
)cWood Frame ❑Individual (se, tank,etc.) all floors,based on exterior
T❑Structural steel dimensions
❑Reinforced concrete TYPE OF / • ER SUPPLY •Total land area,sq.ft. /
ID Other—Specify ■ 'ublic or private company (Q fl
❑Individual (well,cistern) NUMBER OF OFF-STREET ,
PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATIN FUEL TYPE OF FIREPLACE
❑Gas Outdoors
❑Oil '+ RESIDENTIAL BUILDINGS ONLY
❑Elect( ty Number of bedrooms
❑ .al TYPE a MECHANICAL
Number of Full
111 Other—Specify t bathrooms
Partial
r
IV. IDENTIFICATION - . •
Name Q� Mailing Address—Number,street,city and State ZIP code Tel.No.
1. 6-?, P6 y, ( Cal Lf K36? -s'7% O
Owner IJSp Pr
L
2. '.J
Contractor Mate License No.
3.
Architect
The owner of this buildin and the undersigned agree to conform to all applicable laws.
g tur appli nt Addre s
Application da
/0/,,li p
PL NING AREA `. FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT.
APP OVED BY N
JEFFERSON OYN}Y HEALTH DEPARTMENT
APPROVED BY: 'i'fji
- - PERMIT FEE` l � ISSUE DATE
RECEIPT NUMBER
5-7 _ 3,5� oZl1�
Y� (47
BUILDING OFFICIAL / A
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