HomeMy WebLinkAboutBLD1988-00062 BUILDING PERMIT APPLICATION
Jefferson County Buildin.Wartment• County Cdurthousd •Port TownsOWash.98368 • 385-9141
N E
I. LOCATION: geographic name S W SIDE OF ROAD 1 FEET
S W FROM INTERSECTION OF ROAD AND 1(j1)6 a)/d1 d u'dROAD
other specific location or landmark:
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yg6„Ati U
PTION:
Lot e/ Block Sui/ )vilie1n
f ) C 5( ( vU
50 0 > 0,.J Tax Number Y<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 El Hotel,Motel, Dormitory at either the U.S.Navy's Trident or
number of units Indian Island Facilities?
❑Wrecking ❑Mobile Home
❑Moving (relocation) 'pther—Specify
T \ / ❑YES ❑NO
❑Foundation only
n/l ",(it (t jAeci ._
OWNERSHIP C� G1 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 buir' g is being changed, nter'prt�osed use.
X� ` is \ 'e
b. Plumbing
2
c. Heating,air conditioning
d. Other (elevator,etc.) 1 �' I \ i ‘ 5)
• TOTAL COST OF IMPROVEMENT $
III.SELECTED CHARACTERISTICS OF BUILDING -j.t \--d.0".`1
PRINCIPAL TYPE OF FRAME TYPE OF SE1NAGE DM SA DIMENSIONS
•Number of Stories
������0 Masonry (wall bearing) ❑Public or Priv
ood •
FrameTi I_ •Total square feet of floor area,
j')7Ut✓i(r ndividu (septic tank,etc.) all floors,based on exterior
0 Structural steel / dimensions
❑Reinforced concrete TYPE OF WATER SUPPLY •Total land area,sq.ft. /
n -
El Public or private company '). / U
❑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
Qal TYPE OF MECHANICAL
Number of Full
-4:1 Other—Specify bathrooms
Partial
IV. IDENTIFICATION- •
Name Mailing Address—Number,,stree city and State ZIP code Tel.No.
1. V CL lf\ -)
(961(I) 6_ , i
rC id 'fer°--e,h-15 Vie<sr{< —62 CK?
Owner r(- PY---F 3 5 I
2. (1
Contractor State License No.
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Signature of applicant Adtess i} C Appligjir ate t
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY
t—r I 0 1( (c--;{ ,. . --.1 I ---- CK/
JEFFER C HE TH DEPARTMENT
APAIPfP) PR RM T FEE ISSUE DATE RECEIPT NUMBER
t /967
,C9-/ic) '/ ' ,----.
7_,.) 1'Cif--) 1
BUILD
DAM Mbi ledayy
The Printery—Port Townsend 0 1 j�
f 1,�
APPROVED
FEB 1 2 111118
JEFFERSON COUNTY
PLANNING St BLOG OEPT
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