HomeMy WebLinkAboutBLD1988-00300 BUILDING PERMIT APPLICATIO l
Jefferson County Buil( Department• County Courthouse • Port Tol nd, Wash.98368 • 385-9141
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I. LOCATION: geographic name S W SIDE OF ROAD ° FEET
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S W FROM INTERSECTION OF ROAD AND di/f-NU �e ati.4' ROAD
other specific location or landmark: �Qf}(ln 4 (c•g `
LEGAL DESCRIPTION: Cr 0/
PA.
(2_ y n
�f Lot �L,tl
Subdivision
77 3 5-0000 3 �� `
Tax Number Y<Section SectionTownship ang
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
❑Alteration 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) )il Other—Specify ❑YES ❑NO
❑Foundation only p�
Q _Vri)0'.) f(&)c
POO I.
USE
OWNERSHIP
❑Full-time Residence
❑Private (individual,corporation,
nonprofit institution,etc.) ElSecond Home: Recreation Cabin,etc.
CIq�
Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: /4'3 ❑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. Heating,air conditioning
d. Other (elevator,etc.)
• TOTAL COST OF IMPROVEMENT $ /f(p
/
III.SELECTED CHARACTERISTICS OF BUILDING CY -
" PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
❑Masonry (wall bearing) •Number of Stories
❑ •Public or Private
•Total square'feet of floor area,
El Wood Frame
❑Individual (septic tank,etc.) all.floors,based on exterior
❑Structural steel 'dimensions
Reinforced concrete TYPE OF WATER SUPPLY •
Total land area,sq.ft.
, El Other—Specify ❑Public or pnvate.company
`VG} NUMBER OF OFF-STREET
Individ,ual''(well,cistern) PARKING SPACES
p ., Enclosed .....:...
--.-.,,;,) PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
❑Oil
RESIDENTIAL.BUILDINGS ONLY
❑Electricity Number of bedrooms
❑Coal TYPE OF MECHANICAL
CI -Specify Number of Full
bathrooms
Partial
-- IV. IDENTIFICATION-
•
Name :Lsrr Mailing Address— Number,street,city and State ZIP code Tel.No.
1. 'TO m 63WC ' 7 / Cli,c�,co_ 12,A. , O 77 , --
Owner
Tc2
2.
Contractor State License No.
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Signatur pplicant —
Address Applic ion dV
a. 73............-....,..4.2./ �
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PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY
Q C1� _
JEFFER d COUNTY HEAL,T DEPARTMENT
APPADO PERMIT FEE ISSUE DATE, RECEIPT NUMBER
A: '-'3
BUILDING OFFI�A /1?, 6 ° �� 1 �
JEFFES
PLANNING °LOG DfPT `r` / / , y - / L 0 ?t
The Mint —Port Townsend l O /� 54
4/ � --
APPROVED
MAY I I '743.c 7 Peri c)
jEffERSON COUNTY
"CAVING&ELOG DEPT
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I NSPEGT I:.)",1 REOUEST
PERM I T OWNER C.3 0/j/