HomeMy WebLinkAboutBLD1988-00284 ak BUILDING PERMIT APPLICATION .
Jefferson County Building artment• County Courthouse • Port Towns.Wash.98368 • 385-9141 \NN\
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I. LOCATION: geographicname SW SIDEOF _ ROAD FEET
N E MAR 16 1968
S W FROM INTERSECTION OF ROAD AND ROAD
�` JEFFERSON COUNTY
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other specific location or landmark: l� L>�.k-- R--42.+n� PItM1'/INr&8106 REPT
LEGAL DESCRIPTION: ? X x
Lot Rlnck Subdivision
Vt -c"\ &--— .-Va 1s3 3 /v 4- 15 x `1),c X. tQ u
Tax Number %Section Section Township Range
II.TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
VO
❑New building ❑Single Family ❑New County Resident
VAddition ❑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 ❑^1obilc Hcmc
❑Moving (relocation)
(Other—Specify ❑YES ❑NO
VD ElFoundation only �/
- �U\MMcat\c,- -Wt-u Tx•-�c —kr_
1 USE
�; OWNERSHIP
❑Full-time Residence
❑Private (individual,corporation,
nonprofit institution,etc.) ❑Second Home: Recreation Cabin,etc.
QO ❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: N f/ ❑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,Vs-- Swats 6-Pc- "` -4,7, K C
c. Heating,air conditioning
d. Other (elevator,etc.)
• TOTAL COST OF IMPROVEMENT $
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME . TYPE OF SEWAGE D SP tS-.i- I DIMENSIONS
❑Masonry (wall bearing) ElPublic or •Number of Stories
•Total square feet of floor area,
❑Wood Frame ndividual (septic tank,etc.) all floors,based on exter'
LiStructural el dimensions...
El Re' orced concrete TYPE OF WATER SUPP •
al land area,sq.ft.
❑Publ' nvate company
Other—Specify NUMBER OF OFF-STREET
Individual (well,cistern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING F EL TYPE OF FIREPLACE
❑Gas O rs
❑Oil RESIDENTIAL BUILDINGS ONLY
❑Ele city Number of bedrooms .
Coal TYPE MECHANICAL
Numb Full
❑Other—Specify
rooms
Partial
IV. IDENTIFICATION-
` Name Mailing Address—Number,street,city and State ZIP code Tel.No.
�N,1
1. RL0 —, co a f Loci .o,r.T 12. A... 796 —
Owner
%�� Pc-.c. k_�e_ "1:712l r.t�4� CtF2..0 9?Y/
2.
Contractoy State License I\lo. I
I
3.
Architei;t
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
N c D��
JEF•F'pp ER ®-IEALTH DEPARTMENT
APPROVED Y: PERMIT FEE ISSUE DATE
RECEIPT NUMBER
v.
MAR i d 1 sa-=1 c►ur,Q-Fc CO3oo7
BUILDI ®186-OEPT
The Printery—Port Townsend
APPROVED �OG� �
MAR I8 1988 "` L
JEFFERSON COUNTY
PLANNING 5 BLDG DEPT
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