HomeMy WebLinkAboutBLD1988-00273 BUILDING PERMIT APPLICATION
Jefferson County Buildir .'partment• County Courthouse • Port Towns, Wash.98368 • 385-9141
N E •
I. LOCATION: geographic name S W SIDE OF 'OAD _ FEET
N E / '48�
S W FROM INTERSECTION OF ROAD AND 0 0 . .__ A 44��, AT•
other specific location or landmark:
LEGAL DESCRIPTION: t a �r"�
i t _ ,., � t Block ^(15;
( Subdiv. io
# * 111111
-)/77o if
Tax Number 'A Section Section Township Range
II.TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILD NG TYPE MOBILITY
❑New building Single Family ❑New County Resident
❑Addition Multi-Family Is this structure to serve the residential
Iteration number of units 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 ❑YES ❑NO
❑Foundation only
r. OWNERSHIP USE
P-0—2 64"
"i ❑Full-time Residence
❑Private (individual,corporation,
t-� 1 nonprofit institution,etc.) � ? ❑Second Home: Recreation Cabin,etc.
�J ❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: / �J ❑Second Home: Future conversion to
permanent residence
0 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
t 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 1- C6��
c. Heating,air conditioning G/�
d. Other (elevator,etc.)
• TOTAL COST OF IMPROVEMENT $
III.SELECTED CHARACTERISTICS OF BUILDING -
�' PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL / DIMENSIONS
w` Masonry (wall bearing) •Number of Stories
❑ g ❑Public or Pafi6ate
•Total square feet of floor area,
❑Wood Frame ` ❑Individual (septic tank,etc.) all floors,based on exterior
❑Structural steel dimensions
TYPE OF WATER SUPPLY
❑Reinforced concrete •Total land area,sq.ft.
El Other—Specify ElPublic or private company
NUMBER OF OFF-STREET
❑Individual (well,cistern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors V
❑Oil RESIDENTIAL BUILDINGS ONLY
❑Electricity Number of bedrooms
❑Coal TYPE OF MECHANICAL
❑Other—Specify Number of Full
bathrooms
Partial
IV. IDENTIFICATION -
Name (( Mailing Address`es Number,street,city and State ZIP code Tel. No.
1.Owner 0 Ij , I / 1�� ��
Ocit-ec . p)
2.
Contractor State License No.
3.
Architect .,
he owner of this building and the undersigned agree to conform to all applicable laws.
nature of applicant Address Applicat
,��'��'>�;-.� .ter';� ��.--,_. __ C -%-1JZ - �
PLANNING AREAA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY 1 f
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4 UNTY HEALTH DEPARTMENT 7 i B a
APPIi� E D PERMIT FEE ISSUE DATE RECEIPT///NUMBER
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BUILD 7////
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PLANNING &BLDG DEPT .
The Printery—Port Townsend
411 SKETCH PLAN ON GRID BEL•
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APPROVED
JUL 1 i
JEFFERSON COUNTY
PLANNING&8tO&øPT
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