HomeMy WebLinkAboutBLD1988-00290 BUILDING PERMIT APPLICATIOAK
Jefferson County Buil•Department• County Courthouse •Port Tollirnd, Wash.98368 • 385-9141
N E •
I. LOCATION: geographic name S W SIDE OF / ROAD , ' ! FEET
S W FROM INTERSECTION OF ROAD AND /(�C�9 OTC - ROAD
other specific location or landmark:
LEGAL D SCRIPTION:
Pr}—{) I Lot Block Subdiv sion
�OC�1 "'^^j V l r Tax Number %a Section Section Township IR rig-e.
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
-e, ❑Alteration number of units or commercial needs of those employed
❑Repair,replacement Li Hotel,Motel, Dormitory at either the U.S.Navy's Trident or
Cj number of units Indian Island Facilities?
❑Wrecking ❑Mobile Home
❑Moving (relocation) ❑Other—Specify ❑YES ❑NO
❑Foundation only
0 PI
OWNERSHIP USE
❑Private (individual,corporation, ❑Full-time Residence
nonprofit institution,etc.) ❑Second Home: Recreation Cabin,etc.
❑Public (Federal,State or local gov't.) UBC OCCUPA Y GR UP: 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 pt�,)� �',,,�,i____ ,Q`)-f-- z /�
c. Heating,air conditioning Kl L
d. Other (elevator,etc.)
• TOTAL COST OF IMPROVEMENT $
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOS DIMENSIONS
' Masonry (wall bearin ► •Number of Stories
❑ g ❑Public or Private •Total square feet of floor area,
❑Wood Frame ❑Individual eptic tank,etc.) all floors,based on exterior
❑Structural eel dimensions
t TYPE WATER SUPPLY
f
❑Re' orced concrete
Public or private company •Total land area,sq.ft.
6y
c Other—Specify NUMBER OF OFF-STREET
Cr /i ❑Individual (well,cistern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING L
TYPE OF FIREPLACE
,,. Outdoors
❑Gas
—4) ❑Oil RESIDENTIAL BUILDINGS ONLY
-,..s.. ❑Electricit Number of bedrooms
❑Coal TYPE OF HANICAL
ther—Specify Number of Full
r bathrooms
. �,% Partial
IV. IDENTIFICATION -
Name Mailing Address—Number,street,city and State ZIP code Tel. No.
1. `01\CA,rl /0/�" occ.,�� &..t Q y3 -7_
Owner
IA_
I' c- y� III j3? 9/e 3
2.
Contractor State License No.
. 3
Architect
The owner this building and the undersigned a to conform to all applicable laws.
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PANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY
JEFFER N COUNTY H LTH DEPARTMENT.
APPROVED Y: PERMIT FEE ISSUE DATE —
AP � RECEIPT NUMBER
3,, s /0 qqpp s �� 35---5-7
BUIL aF�IL�i�f!
JEFFEnSUN COUNTY )
PLINNIN(;&BLDG OFPT The Printery—Port Townsend
APPROVED
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