HomeMy WebLinkAboutBLD1988-00028 joikBUILDING PERMIT APPLICATION
Jefferson County Building. rtment• County Coui thouse i.Port Townse, Vash.98368 • 385-9141
N E
I. LOCATION: geographic name S W SIDE OF ROAD Lon.Ds FEET
S W FROM INTERSECTION OF ROAD AND S,V rJ L ROAD
other specific location or landmark:
LEGAL DE RIPTION: I(-: ,
Q Lot ^ Block Subdivision
ICJ II 1, OQ.- C74+-, CR(k_.)
C Tax Nber '/a Section S tion owhship Range
II. TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
Ne 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 ❑de obile Home
❑Moving (relocation) ,ni Other—Specify ❑YES ❑NO
❑Foundation only
6 c e_A, ct e—
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: El 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 indu ial plant.
a. Electrical If use of existing building```` ��/� is being changed,enter prop sed use.
b. Plumbing elV K� f CPO
_ P
c. Heating,air conditioning GGGG l/ �/� l LZ r`--��
d. Other (elevator,etc► 1. /l
• TOTAL COST OF IMPROVEMENT $
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,
ood Frame El Individual (septic nk,etc.) all floors,based on exterior
❑S ructural steel dimensions
❑Reinforced concrete TYPE OF WA R SUPPLY •Total land area,sq.ft. t �
❑
❑Other—Specify Pu c or private company jr
Individual (well,cistern) NUMBER OF OFF-STREET
PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATIN UEL TYPE OF FIREPLACE
❑Gas Outdoors
❑Oil RESIDENTIAL BUILDING LY
❑Electrici Number of bedroo
❑Co TYPE OF MECHANICAL
Num of Full
Other—Specify
rooms
Partial
IV. IDENTIFICATION - .
Name Mailing Address—Number,street,city and State ZIP code Tel.No.
1. �o 6c c3 .3 R57c 7 .s.
Owner J [ y� �6,o 7
2. —/\ C(?(:)j a
Contractor State License No. C-j
3.
Architect k
T e ow er of this building and the undersigned agree to conform to all applicable laws.
gnatur of ap l i I Addres Ap icati date
�i '��• . cep ;
PL NING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
PPROVED BY
"FFERSON CO NTY HEALTH DEPARTMENT
7C: � I ® � E Fjj�p�IT-.FEE ISS E DAT c;ECE PT M BE
�� UU
'IL 14 , . ,C0 7 /(/
. L % 7
11EI NY/FIJ TY
1&OLDC DCPT ��
The Printery—Port Townsend
,f6f I
F.FR.tea C-3 1V c t-3 t 3 iif - 'V' -PVC'T T.71-3 T T'i C F3 F.7=Z M
Jefferson County Pinning and Rui ldino Department
Courthouse,. 3rd Floor
PC) Box 1220
Port Townsend . WA a8358
2O6-3€35-y 1 4 1
PERM T T # • RT.ilR8-OO2n T)ATF T SSiiFii. : ill/1 4/AR
STTF. ATSilRFSS ! 50 TOR s LAKF RT)
•QiT T T.CF.NF . WA 8537E
OWNER .TOF. HTCKT F. PH0NF ! 7f 5-3607
MA T LTNC AT)T)R : ROX 32.3
7iiTLC F.ivF. WA gA376
CONTRACTOR. . !Nip CONTRACTOR PHONE:
MATLTNC Ai1DR
CONTR. LTC #! F:XP T RATTON DATE.
PARCFT, NO. . . ! 702111027
T.FCAT. TiFSC. . ! STR 1 1 -27-02 WWM. TAX #
TOT BLOCK
DF.SC R T PT T ON OF T MPROVF.Iv1FNT ! garage
C ; Fontincr/Sethacks (Shoreline Sethack) /Mohi ie Home rs iockincr
C 1 Foundation -
C 1 Ilnderrrround Plumhincn/Iinderaround Tnsulation
C i Framing/Plumhing/Chimney!
( ) Insulation :
C i Sheetrock!
C i Sewage Disposal System Final !
C i Final /Occupancy Approval !
AA/A 0/7+Q- -
CALL 5-y i 41 24 HOURS TN ADVANCE. TO SCHF.DUT F. TNSPFCT T ONS .
Office Hours q a . m. to 5 p.m.
inspector ' s Hours q - in a .m.
24 Hour Recorder for Tnsnectinns.
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