HomeMy WebLinkAboutBLD1988-00034 BUILDING PERMIT APPLICATION
Jefferson County Building lertment• County Courthouse •Port Townseneash.98368 • 385-9141
N E .
I. LOCATION: geographic name S'JV SIDE ODF ROAD r FEET
NE
S W FROM INTERSECTION OF ROAD AND C9 62 f • OA Ett-aROAD
other specific location or landmark: -.4 fr--( Vl (al - ,1
L D SQRIPTION: A
p — }} Lot Block Su div si n \
gJ��,JJJ���, 6lCAN I Cne
/ o7o/ Tax Number Y.Section Secti Township Range
II.TYPE AND COST OF BUILDING-
TYPE OF IMPROVEMENT BUIL ING TYPE MOBILITY
❑New building Single Family ❑New County Resident
Xddition Multi-Family Is this structure to serve the residential
number of units
❑Alteration or commercial needs of those employed
❑Repair,replacement ElHotel,Motel, Dormitory at either the U.S.Navy's Trident or
number of units Indian Island Facilities?
❑Wrecking ❑Mobile Home
❑Moving (relocation)
❑Other—Specify ❑YES ❑NO
❑Foundation only
, 1 i illf-i3C)/rn
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 changed,enter proposed e. ii3Z0
b. Plumbing / ' >,(.o `� 'l /1 ^3 -- 1c. Heating,air conditioning ��J �J
d. Other (elevator,etc.)
• TOTAL COST OF IMPROVEMENT $
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGFL IMENSIONS f
❑Masonry (wall bearing) •Number of Stories '�
❑Public or Private •Total square feet of floor area,
Wood Frame p4ndiv. al (septic tan;l ,etc.) all floors,based on exterior
❑Structural steel dimensions
TYPE QF WATER SUPPLY 1
❑Reinforced concrete •Total land area,sq.ft. N
ublic oiprivate company
❑Other—Specify NUMBER OF OFF-STREET
❑Individual (well,cistern) PARKING SPACES (`---
Enclosed
PIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE '
Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY 1 e-.
ectricity Number of bedrooms
•
❑Coal TYPE OF MECHANICAL
AQther6 S ecif
Number of Full
IOth bathrooms
1 Partial
IV. IDENTIFICATION - .
Name Mailing Address—Number,street,city and State ZIP code Tel.No.
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9g3,_.1, -11
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fr
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rtct"nv..."3
2. jy
Contractor State License No.
'3.
Architect
'The owner of this building and the undersigned agree to conform to all applicable laws.
Signature of applicant Address Ap is t date
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY / ect e• 7
a, 4,,,,,,y,, c a 3/04a
JE F [EAL DEPARTIvIEFiT C)tc_t,,,�
APIt PERMIT FEE IS UE DATE
' ���� RECEIPT NUMBER
37
AU6 1 2 3 v l C /�
53� �(�
BU I L DIJKFIBMINCIANTr Q
`�
PLANNING,&BLDG DEPT 1 -I�0
Printery Port Townsend .,, l a- , � I
The f ( ( 0 %,./
(-7 C)TTT\Tr v T TT: T.i,T' 1\Jtz s1 r..TRTAT i i'
•
Jefferson County P l ann i nn and Ri. i l d i no Department
Courthouse, 3rd Floor
PO Rnx 1220
Port Townsend: WA 9RS36R
2O -3£'S:'1-9141
PRRM T-T' # - RT,l8R-0034 T)ATF TSSTTRT). - 03%1 5%SR
S T Tr. AI7fRF.SS - 261 W KTNKATT)
! PORT HAT)T,OCK. WA 98339
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l)W'IV F,!( I;HARI,F.S RAR-I-A IV F.IV
PWONF - 3R5-1 i 7 R
MATT,TNC A DR : 2n1 KTNKATT)
-PORT HAf)T,OCK WA 98339
ONTRACTOF . . -IVO CONTRACTOR PT'ONF:
MATT,TNC Af)T)R -
CONTR. T,T C #! FXPTRA T T ON i7A TF
PARCF.T, NO. . . - gfi1R07-40i
T,FCAi, DF.SC . . -STR 34-3O-01 WWM. TAX #
LOT 4&5 , BLOCK 74 TRi',NT)AT,F Inal-11365 trMa.IllabiNeL 01- profe2A^e. k
T)F.SCR T PT T ON OF T MPROVF.MF.NT- single family addition : living room
) FontincT/Sethacks (Shoreline Sethar-k) iMnhi lP Home Blocking!
i Foundation -
; Underground Plumhinnitjndprnrnund Insulation -
) Framing/PiumhinaiChimney:
insulation -
( ) Sheetroc-k :
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i ) Swan Disposal System 7 '--a l -
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Final /Ocnunannv Annrova ' -
CAT.T. 385-9141 24 HOURS TN AI)VANCF TO scr-u TitiT,F TNSPFCTTONS .
Office Hours 9 a . m . to 5 p.m.
Tnsnec:tor ' s Hours 9 - 10 a .m.
24 Hour Recorder for Tnsnections.
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