HomeMy WebLinkAboutBLD1988-00297 •BUILDING PERMITAPPLICATION Jefferson County Buildingartment• County Courthouse •Port Townsen , vlfash.98368 • 385-9141
N E ,
I. LOCATION: geographic name S W SIDE OF ROAD FEET
N E S W FROM INTERSECTION OF ROAD AND C �
,i'A 1 in0f/ , ai ROAD
other specific location or landmark: ♦ iV 1 I V t\ e1 F.
LEGAL•DESC IPTION: c )q
� _ Lot —BfotTc Svin 1
700 v t i..( Tax Number Y.,Section Section Township `Range
II.TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
TNew building ,`,, Single Family CI New County Resident
❑Addition\ ulti-Family Is this structure to serve the residential
number of units or commercial need:of those employed
❑Alteration p Y
❑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
ID YES ONO
❑Foundation only
USE
OWNERSHIP
❑Full-time Residence
❑Private (individual,corporation,
nonprofit institution,etc.) > CI Second Home: Recreation Cabin,etc.
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: i'r 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 p.,L4A__,
�� 5-0, 7
4.- e .
c. Heating,air conditioning
d. Other (elevator,etc.)
�« L'1 f.9 .
• TOTAL COST OF IMPROVEMENT $ ,,,, ;---y. (-7
`a) III.SELECTED CHARACTERISTICS OF BUILDING - r— j
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGES •' DIMENSIONS
g...„,,..,❑Masonry (wall bearing) ❑Public or Privat
\,S ��"+ •Number of Stories
•Total square feet of floor area,
KI-".1' ood Frame )Individu(eptic to tZ)etc.) all floors,based on exterior
dimensions
tructural steel
TyPE WATER SUPPLY
❑Reinforced concrete •Total land area,sq.ft.
ublic or private company
..."5
❑Other—Specify ❑Individual (well,cistern) NUMBER OF OFF-STREET
SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY
',electricity Number of bedrooms ./
CI goal TYPE OF MECHANICAL
Number of Full v�/�
eifej-L/✓�Soe� Y bathrooms
11 Partial
IV. IDENTIFICATION- •
+\ Name _ Mailing Address—Number- street,city and State ZIP code Tel.No.
40( 0 F.).-b i'DuX ir- 9-7E.,;-..,x/ --3-C>;--)
wner aw
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2.
Contractor State License,No.
3.
itect
T owner his bu• it a l t e undersigned agree to conform to all applicable laws.
g lure pplic �, AZ Appli anon/d/a/teJ// '
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
A PROV D Y
EFFERSO COUNTY HEALTH DEPARTMENT
APPRQVFD,$ i, PERMIT FEE ISSUE DATE RECEIPT NUMBER
51-
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BUILDING OFFICIAL , 3 ( S (to
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JEFFERSnw COUNTY ` / c1 C-� —
PLANNING St BLDG DEPT h$ ri ery—Port Townsend
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APPROVED
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JEFFERSON COUNTY WAWA (7cer // � l
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