HomeMy WebLinkAboutBLD1988-00004 BUILDING PERMIT APPLICATION It
r , .Jefferson County Building. artment• County Courthouse •Port Townse Yash.98368 • 385-9141
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I. LOCATION: geographic name S W SIDE OF ROAD FEET
NE
S W FROM INTERSECTION OF ROAD AND 3 o fi° q 1 ROAD
other specific location or landmark: I t/fJtejlt— ‘`L""`1,"`/'e
LEG,�A' L D CRIPTION:
i' � ( Lot Block 3 Subdivision
` v ✓ O q Tax Number '%Section Seca Township Range
II.TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
RI ew building - tingle Family ❑New County Resident
i"■ •edition `-■ ulti-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
f
❑Moving (relocation)
Other—Specify CI YES ❑NO
❑Foundation only
XI,E 4,,/Zerit
OWNERSHIP USE
❑Full-time Residence
❑Private (individual,corporation,
nonprofit institution,etc.) ❑Second Home: Recreation Cabin,etc.
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP:4, % ❑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 l�' R k L y.. o�
c. Heating,air conditioning ?to Z I I 254e g cf-',-.: /6S-6
d. Other (elevator,etc)•
e If / 2-GrJ
• TOTAL COST OF IMPROVEMENT $
n
. III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS i /� /^
ElMasonry (wall bearing) •Number of Stories // L d4'1
❑Public or Private
•Total square feet of floor area,
'Wood Frame individual (septic tank,etc.) all floors,based on exterior •
❑Structural steel dimensions 90 J
❑Reinforced concrete TYPE OF WATER SUPPLY •Total land area,sq.ft.
❑Other—Specify ❑Public or private company Si Z� /J '
ndividual (well,cistern) NUMBER OF OFF-STREET
PARKING SPACES
Enclosed 2—
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
LI Gas ,,� '� Outdoors
❑Oil �� ''.
RESIDENTIAL BUILDINGS ONLY
❑ElectricityNumber of bedrooms �—
TYPED MECHANICAL
❑Coa�
�O other—Specify Number of
Full /
bathrooms
• Partial
IV. IDENTIFICATION- .
Name Mailing Address—Number,street,city and State ZIP code Tel.No.
. Z kj c . 10,0 . 16 /CY3 ��
Owner � ��`^ l) t( PI
2. Q C,.) ri 6'r.l_
Contractor State License No.
3 /r
Architect —
T e owner of this building and the undersigned agree to conform to all applicable laws.
Aare of applica Address A licatioi date
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY ° ,l ,r4`r ,, f„, ;,
JEFFER N COUNTY HEALTH DEPARTMENT
APPRQVEp Y: ✓irPERMIT FEE ISSUE DATE RECEIPT NUMBER U 13, (ow
3 c JSU ,)e 2..,
BUILDING OFFICIAL `" 7
JFFFFRgt1pi,.68DN ' 0 21
PLANNING&BLDG DEFT The Printer y—Port Townsend
,
-T ;="- . .R:ems C) J'\T C; i~J L' N -1""Y
Jefferson County P i ann i no and F u i l d i ng Department
Courthouse , .Srd', Floor
PO Fox 1 22n
Port Townsend , WA `-Ies.inrs
2O6-3R 5-9 1 4 1
PRRM T T # • Rl.D R-0004 JATr. T SS'(JN.iI . : it1 •' (i/rsrs
S T T N, A DRESS t 1 30 F''.(O(O K T RD
' t:H T lMAC;t1M. WA 953I5
OWNRR • LYNN FSr.t;KH0RN PF-it)N
Iviesii,I'IV'h AI)I)R : Pt) I-LJX 1043
: PORT TOWNSFND WA 95365
CONTRACTOR . . :NO CONTRACTOR PF''O M.
MATI,TNO AffR :
•
CONTR . LTC #: r.XPTRATTON t)ATF :
PARCRT, NO. . . : QO 1 334t)1 1
i,FGA1, iIRSC. . : ST-R 33-29-01 WWM . TAX
LOT FLOCK RO JJhSF''j, ST,Tr,Wr. SP
DRSC;R T P-f I OIIV nr7 T MPROVRMRNT : garage with loft
) !'-ooting/SPthacks (Shoreline SPthar:k) /Mohi iP Homp Blocking '_
foundation :
1 Underground P iumbinn/iTnclprgrnnnn insulation :
) Framing/Plumbing/Chimney:
( i insulation :
, S'npitrock :
( i SPwarr€ Disposal System Final :
CALL 3R5-91 4 1 24 HOURS TN AIJVANCF. TO SC;Hh,fltILFI T:IrN.t; :'T O)NS _
Office Hours 9 a . m. to 5 p. m .
inspector ' s Hours - 10 a . m .
24 Hour Recorder for inspections .
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