HomeMy WebLinkAboutBLD1988-00008 kOILDING PERMIT APPLICATION .
Jefferson County Building Depa.,ment• County Courthouse •Port Townsend,-t.98368 • 385-9141
N E •
I. LOCATION: geographic name S W SIDE OF ROAD FEET
NE •
S W FROM INTERSECTION OF ROAD AND ' ` =:—'f' i\Nt ? J'li .DAAD21,,
other specific location or landmark:
LEGAL�D,ESCRIPTION: 1C :;'=� c< -1-
pA%l1� Lot Block Subdivision
701 i.► off+ X b<( ‹ Z7 1 w/
Tax Number Y.Section Section Township ' Range
II.TYPE AND COST OF BUILDING-
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY •
ew 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 CI YES ❑NO
❑Foundation only
USE
OWNERSHIP
❑Full-time Residence
❑Private (individual,corporation,
nonprofit institution,etc.) ❑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
• 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 Jchanged,enter proposed use.
b. Plumbing fl' /(..,oey� /'��-/Vre 2 3O �1 440
I I twv ° �✓ 1 Y `7� 11 Q5�
c. Heating,air conditioning [/2TAP-//� /� 9 /
d. Other (elevator,etc.) 6 ll �1 l
• TOTAL COST OF IMPROVEMENT $ ,P Y 37 !l -' -..
/
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
Masonry (wall bearing) •Number of Stories
_❑ ❑Public or Private •Total square feet of floor area,
Wood Frame rx liZI Individual (septic tank,etc.) all floors,based on exterior •
ElStructural steel dimensions
TYPE OF WATER SUPPLY ,'S•l`{ Ike—
❑Reinforced concrete / •Total land area,sq.ft.
1-3 Other—Specify ta.Public or private company ,
NUMBER OF OFF-STREET
\ ❑Individual (well,cistern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY
®Electricity Number of bedrooms '
El Coal TYPE OF MECHANICAL
❑Other—Specify Number of Full C /
bathrooms /
I Partial
IV. IDENTIFICATION-
Name Mailing Address— NJumber,street,city and State ZIP code Tel.No.
1. . C� _) 0 1 M 1 1 ��,, , erg
Owner
00 /) )e/1.(ems.u-e -
i
/fir �, '�^ yi (� i ''��,^ n i
2. L-v 4 Yrf Q/i 2 V �i i S1 '✓ -tT -s`�r/.�7 ' �7���
C
ontractor �� ������-��,, H(,MRS State License No. f`d'� v j6p�%�
k i()Cl)006(
i
Architect
The owner of this building and the undersigned agree to conform to all applicable laws. /
Signature of applicant Address Application date
X -)(61 /nR/R8
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY
JEFFFI C HEAL, DEPARTMENT •
APPR E PERMIT FEL ISSUE DATE RECEIPT NUMBER
I ' $7-D 3 i '7 qo
iu , 0.-D 9\ 1((" (
BUILDILI NNI I OVISTIN Y / S c Q ..._
l _ C� (The Printery—Port Townsend
�j7 I
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pipm
t r Tr r'-+ F: roc t;' T t`7 t-'3 T TiT E V r=s i i T T.i 3 T Tv t r=- ram.TZ TA i T'
.Tpf fprsnn County P 1 ann i no and Ru i i ci i no pnartmpnt
Con r thou_sp . 3rci F 1 nor
PO Box 122n
Port Townspnn . WA 9S3nis
206-3R5-q 1 41
PERM T T # • r'3T,i3Fsis-onnR T)ATF TSST F . - ._
STTF. AIJt, . , , RHOfDODF.NT)RON DR
-n)iiTT.i F.iVF. . WA 98376
OWNER • .TAMFS ROUGH PHC)NF. -
MATT,TNn A 0R - i541 123R1-) ST
- RF.T,T,F`v'IF. WA 9R005
CONTRACTOR . . -NO CONTRACTOR PH0NT.
MATT,TNO AT)T)R -
•
•
CONTR. LTC #- FXP T RAT T C)N TIATF. -
PARC:FT, NO . . . - 7c01 34402g
T.FSAT, TIFSC. . : STR 34-27-0 1 WWM. TAX
T O T� in BLOCK
.
1 SCRTPTTON OF TMPROVFMRNT - s i nn i p family rps i npncp
) Fontinccj/Spthacks (Shnrp3inp Setback) jMnhiip Pomp Rioc:kincj-
i ) Foundations
•
) TTndprornunc3 P1 umh i ng/Unnprgrounc3 insulation !
) Framing/Plumbing/Chimney:
) insulation !
•
) Snpptrock -
•
, Spwaccip T//isnnsa I System Final !
i ) Final /Occupancy Approval !
CALL 355-9 1 41 24 Forms TN AfVANCF TO SCHFfi;T,F TNSPFCT TONS .
Office Hours 9 a . m. to 5 n. m.
Tnsnpctnr ' s Hours 9 - 10 a .m.
24 Hour Recorder for T nsnpct i nns .
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