HomeMy WebLinkAboutBLD1988-00385 • BUILDING PERMIT APPLICAON '
Jefferson County Budding Department• County Courthouse • Port Townsend, Wash.98368 • 385-1310
N E
I. LOCATION: geographic name S W SIDE OF ROAD FEET
NE /,.�
S W FROM INTERSECTION OF ROAD AND 30 (10 1,hh3 1 e_ ROAD
other specific location or landmark: Cj
EGAL DE RIPTION:
- attr'Ce_I Lot Block Subdivision CO
2 fl-I3 Tax Number Yr 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
number of units
❑Alteration or commercial needs of those employed
El Repair,replacement ❑Hotel,Motel,Dormitory at either the U.S.Navy's Trident or
number of units Indian Island Facilities?
❑Wrecking // Mobile Home •
El Moving (relocation) her—Specify ❑YES ❑NO
❑Foundation only
t , ..
USE
OWNERSHIP
❑Full-time Residence
❑Private (individual,corporation, ❑Second Home: Recreation Cabin,etc.
nonprofit institution,etc.)
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: 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 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
c. Heating,air conditioning
d. Other (elevator,etc.)
• TOTAL COST OF IMPROVEMENT $ (.
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
ElMasonry (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
❑Structural steel dimensions
❑Reinforced concrete TYPE OF WATER SUPPLY •Total land area,sq.ft.
Other—Specif ❑Public or private company
NUMBER OF OFF-STREET
rn ❑Individual (well,cistern) PARKING SPACES
Enclosed
PRINCIPAL TYPE F HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY
'. ❑Electricity / Number of bedrooms
❑Coal TYPE OF MECHANICAL
❑Other—Specify Number of {Full
bathrooms
Partial
IV. IDENTIFICATION- •
Name Mailing Address— Number,street,city and State ZIP code Tel.No.
f. N ick, Rce4rir�(>es Pc ,P ?8( ) =l d lc t at 339' ?3.2 -
Owner ff ''
�T t()7-7
2.
Contractor State License No.
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Si na ure of applicant Address
Application date
' (-40/05-78t
T.PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY
i.- 3 t A_
JEFFER"+t! t� NTY H TH DEPARTMENT
APPROVE� BY: PERMIT FEE ISSUE DATE
RECEIPT NUMBER
A422
BUILDING OFFICIAL �� �O�P�O
The Printery—Port Townsend
s
57---)ec /4- 4-7<cii7
(''a,tocci