HomeMy WebLinkAboutBLD1988-00320 BUILDING PERMIT APPLICATION
Jefferson County Builc, Department• County Courthouse • Port To nd, Wash.98368 • 385-9141
N E ,
I. LOCATION: geographic name S W SIDE OF ROAD }- FEET
S W FROM INTERSECTION OF ROAD AND Q) Fb(rr rl I IQ ROAD
other specific location or landmark: `Jt P
LEGAL DESCRIPTION:
Qa reef Lot Block Subdivision
9'62. 1 ( D,08 I Tax Number F— Y<Section Section Township Range
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
'tepair,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 ❑YES ❑NO
❑Foundation only
USE
OWNERSHIP
❑Private (individual,corporation,
c"9
❑Full-time Residence
nonprofit institution,etc.) ❑Second Home: Recreation Cabin,etc.
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: 12->? ❑Second Home: Future conversion to
COST permanent residence
(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.
067
O b. Plumbing fi67 e- EY/S7/^r) CA)/"Cc-c_ "fce <)
C),., c. Heating,air conditioning
/
d. Other (elevator,etc.)
2 • TOTAL COST OF IMPROVEMENT $ 3800c/53-
,-.,..i 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,
❑Individual (septic ,etc.) all floors,based on exterior
Structural steel dimensions
TYPE OF ER SUPPLY Total land area,sq.ft.
❑Reinforced concrete •
❑Other—Specify ublic or private company
CDIndividual (well,cistern) NUMBER OF OFF-STREET
PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
❑Oil
RESIDEN AL BUILDINGS ONLY
❑Electricity Nu 'er of bedrooms
❑Coa TYPE MECHANICAL
they—Specify Number of Full
bathrooms
Partial
IV. IDENTIFICATION -
•
Name Mailing Address—Number,street,city and State ZIP code Tel.No.
1. 6,/1/ i 'cN7a„f -79/ /` /rrnieWN7— /2d I'D - 83` g. 3g.)..
Owner
19y e, impiE,lu/IIA r� -III, Wf- ??3(0, s7Z
2. 6,$jerrIbrr Al t pc a / 3' Lc-,rCIS. / F,, /C1 3 2.Contractor State License No. y�3�
6 B,E04 woe/Ss iD.S
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
ignat a of awl' nt Address Application date
(3 4V/C?/&8
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY - /
fY oIC ,
. Ief �ra C NTY HEALTH DEPARTMENT
APPROR BQ E PERMIT FEE ISSUE DATE RECEIPT NUMBER
MAY " 91988 )` 63xu
BI91/lu CstQDCI�y4.y L 66 s� eI J q/88 3 Co 00
$tnr,part
The Printery—Port Townsend
APPROVED
i-S4k- ,,f ' e7,- 77-e-rz_ni,L3-' Ok- kipbk—
/
JEFFERSON COUNTY
PLANNING&SLOG CEP 1
\ \
1 ,
C " e.c ---Tk-:::; --------'...,...
---,--:->
L----(155 S
1S cr-
_/- ,
&A._ ,
c/c) _
i
i
t
t
f
I t,