HomeMy WebLinkAboutBLD1987-00452 ILDING PERMIT APPLICATION
Jefferson County Building De tment• County Courthouse •Port Townsend, h.9 68 • 385-9141
N E •
I. LOCATION: geographic name S W SIDE OF R D FEET
NE •
S W FROM INTERSECTION OF ROAD AND OAD
other specific location or landmark: l
G L DE CRIPTION: t ---2L___a_q_., ' lq
�il Lot Block Su visic�a
Tax Number %Section Section Township Range
II.TYPE AND COST OF BUILDING-
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY •
New building ❑Single Family
❑New County Resident
❑A dition ❑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
(.... Home
❑Moving (relocation)
❑Other—Specify ❑YES ❑NO
❑Foundation only
OWNERSHIP USE
❑Full-time Residence
❑Private (individual,corporation,
nonprofit institution,etc.) Eli Second Home: Recreation Cabin,etc.
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: ❑Second Home: Future conversion to
permanent residence
COST (Omit cents)
Nonresidential— Describe in detail proposed use of buildings,e.g.,food
1 • 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
‘444,1
\� 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 ,"
c. Heating,air conditioning �f� �i -
d. Other (elevator,etc.) n<; /
• TOTAL COST OF IMPROVEMENT $ (
i_oic0,),_.,(9-
III.SELECTED CHARACTERISTICS OF BUILDING - N,�
1 PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISP DIMENSIONS
❑Masonry (wall bearing) ❑Public or Private •Number of Stories
El Wood Frame •Total square feet of floor area,
Indivi al (septic tank, c.) all floors,based on exterior •
❑Structural steel dimensions
TYPE OF WA
TER ATER SUPPLY •Total land area,sq.ft.
❑ einforced concrete
❑Public or private company
Other—S fy NUMBER OF OFF-STREET
� ,i _ El Individual (well,cistern) PARKING SPACES
PRINCIPAL TYPE OF HEATING FUEL Enclosed
TYPE OF FIREPLACE
❑Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY f``
Electricity Number of bedrooms
❑Coal TYPE OF MECHANICAL
O t,#ler—S Number of {::iai
IV. IDENTIFICATION-
•
Name Mailing Address—Number,street,city
and State ZIPPcode Tel.No.
Owner , � !c( \ - Pi V , 'i, ,,p6. i J( g / r� �� // t
/
2.
- ontractor State License No.
3
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Signature of applicant Addre s Applicati n dat
Ac-,-
C��,
....._ L /(74
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY d,-. i / ''
JEFFERSON HEALTH DEPARTMENT
APPFjAVRC�R - pMl E ISS E DATE RECEIPT NUMBER
DEC 16Sig a
BU I L DI NROEFORAL� G f I
AL. / V ,
Pi AN.lNC&IWC BCPT G_ I/t
Port TownsendM 4,1 Fps
0
pplimmo"""-'
el: ,
.....1."
b
_
t
0 0
. I r 1 ......
•
‘..
41001..„.•—
• ak I .
i
itaI -,-
4
-. airaZwv%
b Lb at
f.„.
• — _ _ _ H Mae.. or .1
-1 r-
-.
As
o
CP
_ 1 g
(A.
_ a _
.4- n
• •i )..
•-... )..1 10% X.
10' -..
---....
_ .
e- ..51)1 -0-I,
......
4 I
, -
; s -. .-
r•
-0.
O.
4 1.1..
. i
ne...41 12)4.--+Ai i 1
A
-fi..1:51% 0 roait,
t' - - • eixi-,.v.E. bo4.4.-111
4. •, . -,. . : approvel 04,4 or....1
4.,'waSkt.t.r-ocz.
:..°:0 r•` '/ iA,4•...fr p.p4,
ii• •••0 •''.::•
- si.•P --,
I/ f
SeA,It I 1-- c2O
APPROVED
DEC 1 67 --{� S cam,...,
JEFFERSON COUNTY
PLANMIiiS&SLOG DEPT
lit
1 4 /7 5.-;77-6