HomeMy WebLinkAboutBLD1987-00455r 'Ank- BUILDING PERMIT APPLICATION
Jefferson County Building artment• County Courthouse • Port Towns Wash.98368 • 385-1310
s._____41,
N E
I. LOCATION: geographic name S W SIDE OF /LL/ IY
ROAD �I FEET
NE ,3() (C
S W FROM INTERSECTION OF ROAD AND '°`D
other specific location or landmark:L Block
ub• P/CCt
pLErlPTION:
V 1 k�.'nV 1
(A)
67707100 On t 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
. jiAddition ❑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 US.Navy's Trident or
❑Repair,replacement number of units Indian Island Facilities?
❑Wrecking ❑Mobile Home
❑Moving(relocation) Ot er—Spercifyi ❑YES ONO
❑Foundation only ( L--( l` �Vr'S1 dO�i��diiittttll �--
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: />
�--/ 0 Second Horne: 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 f existing buildingil is being changed,enter proposed use. �y/ /
b. Plumbing 1 /74 = 4/5-6 e3,_, /S Z (GV
c. Heating,air conditioning c L7 2`7 ' L/Z e/4.0� vc2 C 6
—r
d. Other (elevator,etc) 2
•
• TOTAL COST OF IMPROVEMENT $
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPO DIMENSIONS
•Number of Stories
0 Masonry (wall bearing) ❑Public or Private •Total square feet of floor area,
)Sr41:4/ood Frame r Individ (septic tank tc.) all floors,based on exterior
! dimensions
Structural steel
TYPE OF W/� ��E�fJ �•
❑Reinforced concrete ••Total land area,sq.ft. 5'
Public r pnvat mpany
❑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 \ rt C.1 W 3
electricity Number of bedrooms 2 E ( 1
❑Coal TYPE OF MECHANICAL
{
Number of Full
❑Other—Specify bathrooms
Partial
IV. IDENTIFICATION- -
•
Name Mailing Address—Number,street city and State ZIP code Tel.No.
1. �fc�7tJ -th C Lr r 0 e/sc� W. `72- 5 0
Owner Mry���/CA
/ //� f l t�( �511/ 1
2. _ ' r
Contractor State License No.
/
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
gn"re of appi atzti...... Add/remiss ' I I_L Application ldateC
a• Afi 0,1 Nut a c u Obk /
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY
JEFFERSON COUNTY HEALTH DEPARTMENT
APPROVED BY: PER Imo;FEE ISSUE DATE RECEIPT NUMBER
' � (� 3
BUILDING OFFICIAL j />`�
7 v C�
The Printery —Port Townsend TO H.
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