HomeMy WebLinkAboutBLD1988-00361 BUILDING PERMIT APPLICATIO 'TN.
Jefferson County Builc epartment• County Cot thouse •Port Tov id, Wash.98368 • 385-9141
N E ,
I. LOCATION: geographic name S W SIDE OF ROAD FEET
NE q
S W FROM INTERSECTION OF ROAD AND 7 ' C o T' ROAD
other specific location or landmark: PO Iisc,„, __ 0,,,-/
`A .( rEGAL DES RIPTION: .�
Lot Block Subdi '
—4,() i (k..._)
' 7I oo()1.9 Tax Number %Section Section Township Range
II.T PE AND COST OF BUILDING-
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
Li 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) Other—Specify
❑Foundation only ❑YES ❑NO
k)0 r)rire----
OWNERSHIP USE
❑Full-time Residence
❑Private (individual,corporation,
nonprofit institution,etc.) //'J�� ❑Second Home: Recreation Cabin,etc.
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP:Jv -' ❑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
V()
c. Heating,air conditioning
(
d. Other (elevator,etc.)
N,i • TOTAL COST OF IMPROVEMENT $
III.SELECTED CHARACTERISTICS OF BUILDING -
) PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
(`'`"""' ❑Masonry (wall bearing) ❑Public or Private •Number of Stories
`*✓ •Total square feet of floor area,
❑Wood Frame ❑Individual (septic tank,etc.) all floors,based on exterior •
LiStructural steel dimensions
TYPE OF WATER SUPPLY11 Total land area,sq.ft.
❑Reinforced concrete
❑Other—Specify ❑Public or private company
•
NUMBER OF OFF-STREET
❑Individual (well,cistern) PARKING SPACES
'(.,�M Enclosed
/`'�C;'.,,4,
" PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY
❑Electricity Number of bedrooms
❑Coal TYPE OF MECHANICAL
Number of Full
❑Other—Specify bathrooms
Partial
IV. IDENTIFICATION •
-
Name Mailing Address—Number,street,city and State ZIP code Tel.No.
m o r-'
( -(0 e_ ho a 0 R - L23Owner ,
z.
Contractor State License No.
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Sfgna licant Addpss A``ppllii ation d e
• ""••••• CeViriV2_ es• 041Ye____
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY tj
f a\c_try_
JEFF SON RUNTY HEALTH DEPARTMENT
AP RO BY �R MI ISSUE DATE RECEIPT NUMBER
P R 0 ,____
‘-'77- ( 8)--- S
BUILDlifer F CAI, \, /
JEFFERSON COUNTY The Printery—Port Townsend
PI,ANYNC,R lSftu:ntn,
APPROVED
JAN 2 2 1988 —� a- ® pee244,, E Crtcy _
JEFFERSON COUNTY
PLANNING&BLDG DEPT
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