HomeMy WebLinkAboutBLD1988-00309 BUILDING PERMIT APPLICATI(i,
Jefferson County Burg Department• County courthouse •Port ToWend, Wash.98368 • 385-9141
N E
I. LOCATION:
N E geographic name S W SIDE OF ROAD
FEET
S W FROM INTERSECTION OF ROAD AND a. 1 CC!mar) P i acfp ROAD
other specific location or landmark: P I
LEGAL DESCRIPTION: 1.C1 *
PctrCe, .- Lot Block • J Co I �I�y
Sub ivi ion
`r39 Co61 43 Tax Number
II. TYPE AND COST OF BUILDING - !+Section Section Township Range
9
TYPE OF IMPROVEMENT
BUILDING TYPE MOBILITY
❑New building
El Single Family
El Addition ❑New County Resident
El Multi-Family Is this structure to serve the residential
Iteration number of units
or commercial needs of those employed
❑Hotel,Motel, Dormitory at either the U.S.Navy's Trident or
❑Repair,replacement
number of units
El Wrecking Indian Island Facilities?
El Mobile Home
❑Moving (relocation)
Other—Specify
❑Foundation only ❑YES ONO
kP pia('i ,r 1=17..her)
e cobints
OWNERSHIP USE
ElPrivate (individual,corporation, ❑Full-time Residence
❑Second Home: Recreation Cabin,etc.
nonprofit institution,etc.)
Cl Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: ❑Second Home: Future conversion to
COST permanent residence
(Omit cents)
• Cost of improvement Nonresidential— Describe in detail proposed use of buildings,e.g.,food
Tot inimpr d bunot included $ processing plant,machine shop,laundry building at hospital,elementary
in the above cost school,secondary school,college,parochial school,parking garage for
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 $ 1 Q
i 60
"' III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL
DIMENSIONS
❑Masonry (wall bearing) •Number of Stories
❑Public or Private
Wood Frame •Total square feet of floor area,
El 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—SpecifyPublic or private company
❑Individual (well,cistern) NUMBER OF OFF-STREET
PARKING SPACES
PRINCIPAL TYPE OF HEATING FUEL Enclosed
TYPE OF FIREPLACE
❑Gas Outdoors
❑Oil
Oil ricity RESIDENTIAL BUILDINGS ONLY
Number of bedrooms
❑Coal TYPE OF MECHANICAL
❑Other—Specify Number of Full
bathrooms
Partial
IV. IDENTIFICATION-
Name Mailing Address—Number,street,city and State
I ZIP code Tel.No.
MelliMil
Owner V �� , •
2. — s on P o
Contractor �► . � . • •, •,
State License o. _
■ - - r�rr
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Signature o ap. icant
/ Address
Application date
- �,_..�� - zz4 e,C-c— �, ,d 5-r 6 3 a1
A �8
PLANNING AR`A FIRE DISTRICT
PAPPROVEDLANNING RY ^ / SCHOOL DISTRICT WATER DISTRICT
JEFFERS° COUNTY HEALTH DEPARTL1ENT
APPROVED B
.; PERMIT FEE ISSUE DATE
Lq5 < oo RECEIPT NUMBER
M A 4 1988 'SO /oR Li hSs)
BUILDING OFFICIAL .Wile . � r\ J
PLANNING&BLDG DEPT � �� �J /
The Printery—Port Townsend
APPROVED
LIAR 2 4 1988
JEFFERSON COUNTY
PLANNING&BLDG DEFT
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