HomeMy WebLinkAboutBLD1988-00390 BUILDING PERMIT APPLICATION
Jefferson County Build, epartment• County Courthouse • Port Tow, , Wash.98368 • 385-9141
N E
I. LOCATION: NoEgrapl�icname S W SIDE O` ROAD I ��✓<✓v FEET
SW FROM INTERSECTION OF ROAD AND 1s7/ 6n- Jc ROAD
other specific location or landmark:
LEGAL DESCR.IITION A.....)
:
�-}-- _ Lot Block Subdivi ' n
oR r n3D I 053 Tax Number '/ Sectio Section Township Range
II. TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
j New building ❑Single Family
❑New County Resident
ddition ❑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 II]YES LINO
❑Foundation only
il>ct.0)).Qc:( 6cUo,
OWNERSHIP USE
40 ❑Private (individual,corporation,
❑Full-time Residence
nonprofit institution,etc.) A
❑Second Home: Recreation Cabin,etc.
f'
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: ❑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 buildin at industrial plant.
I a. Electrical If use of existing building is being� changed,enter propos use. '
b. Plumbing _(DO „r—. l fJ (.1.—)-ee- (1�
` ' / 1/'\
Ito('
c. Heating,air conditioning `�'
d. Other (elevator,etc 1
�"'q • TOTAL COST OF IMPROVEMENT $
*•/..,/,.,/ III.SELECTED CHARACTERISTICS OF BUILDING -
DIMENSIONS
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSA� 1
- ❑Masonry •(wall bearing) •Number of Stories lI
❑Public or Private
Wood Frame •Total square feet of floor area,
❑Individual (s-c is tank,etc.) all floors,based on exterior
❑ tructural steel dimensions
TYPE OF '•ATER SUPPLY Total land area,sq.ft. I
❑Reinforced concrete •
❑Other—Specify Pt •ublic or private company 1 ? 79 -
NUMBER OF OFF-STREET
❑Individual (well,cistern) PARKING SPACES ---
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outd
❑Oil --'`
RESIDENTIAL BUILDINGS ONLY
/ lectricity Number of bedrooms
////❑Coal TYPE OF M ANICAL
CD —Specify Number of Full
bathr s
Partial
IV. IDENTIFICATION - `
Name Mailing Address—Number,stree city and State ZIP code Tel.No.
. [kj CRC)( 10�J - 9t /C)7
Owner
''"32- /'-ico 7
2.
Contractor State License No.
3.
Architect
The o ner of this bui ing and • dersigned agree to conform to all applicable laws. •
I
7,\Si ur' of applic •/� Addre 411 / p ( P2tiond
PLANNING ARE IRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY
1 mow
JEFFERSON COUNTY HEALTH DEPARTMENT
APPRA/P3 \ 0 V E D PE ROO FEE ISSUE DATE RECEIPT NUMBER
.co3 6,/a 88 / 0'77 (to
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The Printery—Port Townsend
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