HomeMy WebLinkAboutBLD1988-00061rBUILDING PERMIT APPLICATION 4
Jefferson County Buiiding•artment• County Courthouse •Port TownsNash.98368 • 385-9141
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I. LOCATION: geographic name S W SIDE OF_ ROAD FEET
NE W4 I if , /� j
S FROM INTERSECTION OF OA '1D AND �" t (� / I ROAD
Ir-- •..
other specific location or landmark: ( ,O ^L
LEGAL DE SCRI TION: ' J
PA— W Lot Block Sub;'si
a (-1
7itu
o,ou
q 75-7- D? ( Tax Number /<Section Section Township Range
II. TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
New 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 ElHotel,Motel,Dormitory at either the U.S.Navy's Trident or
number of units Indian Island Facilities?
❑Wrecking /J�Mobile Home
❑Moving (relocation) —\
❑Other-Specify ❑YES ENO
❑Foundation only
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: ❑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 changed, proposed use.
b. Plumbing ) X/
c. Heating,air conditioning / ( 1 v1 A
d. Other (elevator,etc.) t ((JJ(A� l f/ C) U
TOTAL COST OF IMPROVEMENT $
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DI P DIMENSIONS
Masonry (wall bearing) •Number of Stories
❑ ❑Public or Pri
•Total square feet of floor area,
❑Wood Frame ndividu (septic tank etc.) all floors,based on exterior
ID Structural steel dimensions
TYPE OF WATER SUPPLY
❑Reinforced concrete •Total land area,sq.ft.
Other-Specif ❑Public or private company
y NUMBER OF OFF-STREET
��/�ial 1-0 ❑Individual (well,cistern) PARKING SPACES
Y V 1 Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
UJI RESIDENTIAL BUILDINGS ONLY
lectricity Number of bedrooms
El Coal TYPE OF MECHANICAL
Qth S cif Number of Full
/I �%�/ v}� bathrooms
(Q.LI !l ) t--� Partial .L.
IV. IDENTIFICATION- •
Name Mailing Address-Number,street,city and State ZIP code Tel.No.
t. \69". CXIC)a-41 601(
Owner
3
2.
Contractor State License No.
3.
Architect
v
The ow of this building and the undersigned agree to conform to all applicable laws.
i Signet re fappli Addres
/J App/iona t
C
, 7 . 1/^ ( 2( r--- / LA-(7.ke;) aIQ__ 7/1 , P ANNING AREA FIRE DISTRICT SCHOOL D STRICT WATER DISTRICT
APPROVED BY l 0 jc 7/
JEFFERSON COUNTY HEALTH DEP�TMEN
APPROVED BY: PERMIT ISSUE DATE RECEIPT NUMBER
C 3c1
61C�
BUILDING OFFICIAL 3, J
�_ '� in y-Port Townsend y -'-
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