HomeMy WebLinkAboutBLD1988-00319 WILDING PERMIT APPLICATION
Jefferson County Building Dep� ,ent• County Courthouse • Port Townsend, 98368 • 385-9141
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I. LOCATION: geographic name S W SIDE OF ROAD •
FEET
NE
S W FROM INTERSECTION OF ROAD ND q0 O ,(/I CJ� ROAD
other specific location or landmark: IV 0 V (3j il
LEGAL DES RIPTION:
ot� Block Sub 'visi
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&X-10
CIO 63 Tax Number %Section ection Township Range
9
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
number of units
❑Alteration 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) fii'�ther-Specify ❑YES ONO
❑Foundation only V ^
USE
OWNERSHIP
❑Full-time Residence
❑Private (individual,corporation,
nonprofit institution,etc.) ❑Second Home: Recreation Cabin,etc.
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❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: iz` ❑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.
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b. Plumbing �(.� ) -. 76g li�
�T ♦ 6 S
c. Heating,air conditioning P� V j` r` ...,
lb .AL
d. Other (elevator,etc.) -
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0' • TOTAL COST OF IMPROVEMENT $
III.SELECTED CHARACTERISTICS OF BUILDING -
,a
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
�
Masonry (wall bearin ► •Number of Stories
�* ❑ 9 ❑Public or Private •Total square feet of floor area,
W ood Frame ndivi septic tank, tc.) all floors,based on exterior
•Structural steel dimensions
❑Reinforced concrete TYPE OF WATER SUPPLY •Total land area,sq.ft. q�❑Public or . ' e company �
fit ❑Other-Specify �/ NUMBER OF OFF-STREET
.,, f�/J Ind'od istern) PARKING SPACES
t� Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY
(
Electricity Number of bedrooms
❑ oal TYPE OF MECHANICAL
{
20thYr-Speci y Number of Full
��\\ /� bathrooms
( L l(J r Partial
IV. IDENTIFICATION - `L,( /
Radtak
Name g AldddrresS-Number,street, and State ZIP code Tel.No.
1.
Owner^A( _79r' �� ' 1et ts
n ra YYVA, "�l IS State License No. a..�CO�l I3 C C? ts -f ✓ 7 —
P L_ W 5
3.
Architect ,,
The owner of this building and the undersigned agree to conform to all applicable laws.
Signature of applicant Addr ss
�t6'PQ n Application ate& ��
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PLANNING AREA FIRE DISTRICT SCHOQL DISTRICT WATER DISTRICT
APPROVED BY 0I� (c( i'/ / 0 -�1'/ /
JEFF :it COUNTY HEALTH DEPARTMENT
APPRg,�i' A V ERMLT EE ISSUE DATE RECEIPT NUMBER
11l�i� �._ r�C�-� S���
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BUILDINIXERfigtitl}tINTY - .
PLANNING&Pilif._DEPT v A
L.. 3 e Printery-Port Townsend D W/i 7/ '/ •y'.
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APPROVED
JEFFERSON COUtirSt
PLANN EIL EING& fT
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