HomeMy WebLinkAboutBLD1988-00012 BUILDING PERMIT APPLICATION
Jefferson County&filchØepartment. County Courthouse •Port Town•, Wash.98368 • 385-9141
N E
I. LOCATION: geographic name S W SIDE OF ROAD FEET
N E � 2 ) n
S W /
FROM INTERSECTION OF ROAD AND f"P/,J / \ r ROAD
other specific location or landmark:_
pL GAL DES RIPTION: PT� LowBlock Subdivision-- 30 I
k,..)
r -C-, Tax Number f<Section Section owns ip Range
II. TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
/ 1 New building []Single Family ❑New County Resident
❑Addition ❑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 U.S.Navy's Trident or
❑Repair,replacement
number of units Indian Island Facilities?
❑Wrecking ❑Mobile Home
❑Moving (relocation)
Other—Specify ❑YES ❑NO
❑Foundation only 1,4
OWNERSHIP 7`'1Y'(3\P C1Z .) E
c- Full-time Residence
❑Private (individual,corporation, k)d PI! Second Home: Recreation Cabin,etc.
nonprofit institution,etc.)
CI 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 buildi . at industrial plant.
a. Electrical If use of existing building is being changed, •-ter propo ed use.
fir' 40��
b. Plumbing '� ':����� ��A` �,'�/1�� e
c. Heating,air conditioning 4.131) @D• 4- -76 e
d. Other (elevator,etc.) t 1 4 a. A_, ✓
s
• TOTAL COST OF IMPROVEMENT $ ?ig
�3 �"
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
❑Masonry (wall bearing) El Public or Private •Number of Stories �7
•Total square feet of floor area,
Wood Frame ❑Individual (septic tank,etc.) all floors,based on exterior
❑ ructural steel dimensions
ID concrete Ti al F WATER SUPPLY •Total land area,sq.ft. 5
lid i<!4' blic or private company
El 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
❑Electricity Number of bedrooms
❑Coal TYPE OF MECHANICAL
_XO h r—SP•ciAl
Number of Full
bathrooms
•.rtial
IV. IDENTIFICATION - •
Name Mailing Address—Number,street,city and State ZIP cod Tel.No.
A.) 1, C�, Y�c�o _ 17..c- / Y��� ,�)/1�
Owner
iiil
2.
Contractor State License No.
3.
Architect
wner of this building and the undersigned agree to conform to all applicable laws.
gn ire of applican
The „....,!:___„
Add ess Applica ion ..ate
1 �
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY � � �_
...IV ER'-\i•N COUNTY HEA.,TH DEPARTMENT
A •"'• / PERMIT FEE ISSUE DATE � NUMBER
l i TOO REC£I. T
p� 3 l
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BUI lamAR 'FF'C�08L 3i� �3///
,gPLAh'trlrtr• N CUUNTY
-4 met,orPT TCC90 SZ)
The Printery—Port Townsend rep 1-- /0 �l/
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.i F-F'F T.r.TRC7i\7 (-c 1-7W9 V' 1 tTT T.T)T TTC; 1✓' FF TVTT T
Jefferson County Planning and Ruiidinn Department
Courthouse, 3rd Floor
PO Rox 1220
Port Townsend, WA 98388
206-385-9141
PF.RMTT * •RT.DRR-001 2 DATF T SSTTFD. :03/1 1 /RR
STTF ADDRESS: rn 1 31 CAPF. ORORCF RD
: PORT TOWNSFND, WA 98388
OWNER -STFVF.N HARERSF.TZ.F.R PHONF. :
MATT,TNO ADDR : n1 ;s1 CAPF. GFORGF RD
:PORT TOWNSRND WA 98368
CONTRACTOR . . :NO CONTRACTOR PHONE.-
MATLTNO 'MDR :
CONTR . T,TC #: FXPTRATTON DATE !
PART;F.T, NO. . . : OO1 A01 O25
T,F.OA T, DFSC. . : STR :10-30-01 WWM. TAX
T,OT . RT,OCTC
DFSCR T PTTON OF TMPROVFMFNT: detached shoe
( ) Footing/Setbacks (Shoreline Setback) /Mobile Home Blocking!
Foundation :
) Tinderoround Plumbing/Underground insulation !
( ) Framing/Plumhingr/Chimney:
( ) insulation :
( ) Sheetrock:
( ) Sewage Disposal System Final :
i Final /i cunancy Approval :
CALL 385-9141 24 HOURS TN ADVANCE TO SCHFDULR TNSPFCTTONS .
Office Hours 9 a .m. to 5 p. m.
inspector ' s Hours 9 - 10 a .m.
24 Hour Recorder for inspections.
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