HomeMy WebLinkAboutBLD1988-00317 BUILDING PERMIT APPLICATION
Jefferson County Buildir•partrnent• County Courthouse • Port Town Wash.98368 • 385-9141
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I. LOCATION: geographic name S W SIDE OF @ ROAD FEET
NE !, 1 F(>
S W FROM INTERSECTION `OF � , ! ROAD,J AND / / UQVJ r/7._Q__ ROAD
other specific location or landmark: \---- foJ�V d Cj-k 2C c f e) p
liLEGAL DESCRIPTION: I ti�
)194-a-Q, , Lot Block ,--72 Subd sj (A.)I )t../U Tax Number 1/4Section Section Township Range
a II. TYPE AND COST OF BUILDING -
•
TYPE OF IMPROVEMENT I BUILDING TYPE I MOBILITY
1 Li New building ❑Single Family ❑New County Resident
'''3
❑Addition ❑Multi-Family
Is this structure to serve the residential
,°. number of units
x' ❑Alteration or commercial needs of those employed
❑Repair,replacement ❑Hotel,Motel, Dormitory at either the U.S.Navy's Trident or
number of units
❑Wrecking Indian Island Facilities?
❑Mobile Home
❑Moving (relocation) cOther—Specify
❑YES ❑NO
❑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: /2"...: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 et 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 $
I
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
❑Masonry (wall bearing) •Number of Stories
❑ •Public or Private
•Total square feet of floor area,
❑Wood Frame ❑Individual (septic tank,etc.) all floors,based on exterior
0Structural steel dimensions
TYPE OF WATER SUPPLY
❑Reinforced concrete •Total land area,sq.ft.
❑Other—Specify ❑Public or private company
- NUMBER OF OFF-
ID Individual (well,cistern) PARKING SPACESSTREET
Enclosed
-""" PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY
❑Electricity Number of bedrooms
1, TYPE OF MECHANICAL
❑Coal
n `" Number of Full
❑Other—Specify
bathrooms
Partial
IV. IDENTIFICATION -
Name Mailing Address— Number,street,city and State ZIP code Tel.No.
******.. I. rl 1 I 1 - / / `1 1 r,. e.>a2.-ruz_ c/ f -c
Owner
1C .ti /------
2.
Contractor State License No.
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Signature of appli nt Address . Application date
r �� c (. X 6--/''-
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY �/
JEFFERSON OU Y ^ AL,TH DEPARTIVIENT
APPRO#P:° : ® PERMIT FEE ISSU DATE RECEIPT' NUMBER
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BU I L DI N 9RFEFREALBuicy
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The Printery—Port Townsend
APPROVED
JEFFERSON COUNTY
PLANNiNG&BLOC OEPT
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