HomeMy WebLinkAboutBLD1988-00063rBUILDING PERMIT APPLICATION
Jefferson County Building Depent• County Courthouse •Port Townsend, 41.98368 • 385-9141
N E '
I. LOCATION: geographic name ' S W SIDE OF ROAD FEET
NE
S W FROM INTERSECTION OF ROAD AND
other specific location or landmark: Pa
ir
��LE A � gR IPTION: - l
� -' Lot Block n Subdivision
966e 9006c
Tax Number %.Section Section To nship Range
II.TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
ew building
❑Single Family El County Resident
Addition ❑Multi-Family
Is this structure to serve the residential
number of units
❑Alteration or commercial needs of those employed
❑Repair,replacement ❑Hotel,Motel, Dormitory at either the U.S.Navy's Trident or
number of units Indian Island Facilities?
❑Wrecking '-❑)Mobile Home
❑Moving (relocation) �❑Other—Specify El YES ❑NO
❑Foundation only
USE
OWNERSHIP
❑Full-time Residence
❑Private (individual,corporation,
nonprofit institution,etc.) ElSecond Home: Recreation Cabin,etc.
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: /2,1 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 industrial plant.
a. Electrical If use of existing building is being changed,enter proposed use.
b. Plumbing /(/, `(
c. Heating,air conditioning
*r - Cc(694 `( -
d. Other (elevator,etc.) V C42 — /�/')eCt)IfO
• TOTAL COST OF IMPROVEMENT $ //� 1
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISCS IMENSIONS
Masonry (wall bearin ► ?�� •Number of Stories
❑ 9 ❑Public or Prly
•Total square feet of floor area,
❑Wood Frame ndivi ual (septic tank etc.) all floors,based on exterior
❑Structural steel a dimensions
❑Reinforced concrete TYP T Y
•Total land area,sq.ft.
Other—Specify ❑Public o private company
NUMBER OF OFF-STREET
rkl ( t n tQ ❑Individual (well,cistern) PARKING SPACES
��KR I.V�Y Enclosed
PRINCIPAL TYPE itIF HEATING FUEL TYPE OF FIREPLACE
CI Gas Outdoors
El •il RESIDENTIAL BUILDINGS ONLY tJ
•lrii Electricity Number of bedrooms
•
❑Coal TYPE OF MECHANICAL
Number of Full C/J
il'Other— pe bathrooms
t�o�(� �yr�f Partial
IV. IDENTIFICATION -
Name Mailing Address—Number,street,city and State ZIP code Tel.No.
Owner Drmyk uW'i r PQ �f(/ l5 .C-4 la Ori ( "'2
2.
Contractor State License No.
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Sig++ature of applicant dres
\ /Ad c Appl' i date
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY i]‘C- \Vz:,` a
JEFFERSON CO HEALTH DEPARTMENT
APPROAI Eri f 1 . roli PERVZ FEE ISSUE DATE
l RECEIPT NUMBER
7.5
AU i b 1986 / m
BUILDING OFFICIAL ..5�l L�
JEFFERSON Mind iS�
PLANNING&BLDG DEPT The Printery—Port Townsend eD q 0
}y._ I J ( JU
• .
7V
I_
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1 1/
APPROVED
AU6 10 1988 �� �j„r.S�e f�c �,t►k c /C
JEFFERSOM COOM
PLANNING&SOW
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