HomeMy WebLinkAboutBLD1988-00271 ill, BUILDING PERMIT APPLICATION
Jefferson County Buildin partment• County,Courthouse • Port Town W, Wash.98368 • 385-9141
N E
I. LOCATION: geographic name S W SIDE OF ROAD FEET
NE � y (�
S W FROM INTERSECTION OF ROAD AND / 0 ,--d67.) ROAD
other specific location or landmark:
,E A DES I TION: )3(t--1 "1
/r�� t 0
,. r
Block
Y 2-� go' Subdivision3 ) ��k)
,vc J Tax Number %Section ection 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
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
❑Foundation only El YES ❑NO
psi-- lk--0 0-\--
USE
OWNERSHIP
❑Full-time Residence
,': ❑Private (individual,corporation,
nonprofit institution,etc.) ClSecond Home: Recreation Cabin,etc.
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP:_g-r3 ❑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
l• 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 -
d. Other (elevator,etc.)
• TOTAL COST OF IMPROVEMENT $? ODD
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,
i ood Frame ❑Individual (septic tan re.-) all floors,based on exterior
0St ctural steel dimensions
TYPE OF WA SUPPLY❑Reinforced concrete •Total land area,sq.ft.
❑Other—Specify ❑P is or private company
NUMBER OF OFF-STREET
Individual (well,cistern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
CI Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY
❑Electricity Number of bedrooms
❑Coal TYPE OF MECHANICAL
ther—Specify Number of Full
bathrooms
Partial
IV. IDENTIFICATION -
Name lMailing Address—Number,street,city afid State ZIP code Tel.No.
1. �l/ V
Owner
Tr
2.
Contractor State License IJo.
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Signature of applicant Address Application date
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY�� 1\D S 24 aS
s ��� �
APED b T., .. t rr�HEALTH DEPARTMENT �� _
PERMIT FEE ISSUE DATE RECEIPT NUMBER
JU 1 1988 . 50 000 ... BS �^
BUILDFME1k��SfNdCU .iy 102 V 3,2C�v2_
PLANNING&BLDG DEPT
The Printery—Port Townsend
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