HomeMy WebLinkAboutBLD1988-00399 BUILDING PERMIT APPLICATION
Jefferson County Building Dement• County Courthouse • Port Townsendh.98368 • 385-9141
N E
I. LOCATION: geographic name S W SIDE OF RO D FEET
NE n
S W FROM INTERSECTION Ohl ROAD ND4 a V.._ ROAD
other specific location or landmark:
AI, D CR PTION:
Alt/� Lot lock r Subdiv sion
a 94 J Itj
?K(. 0 O J07 Tax Number Y.Section n Township Range
II.TYPEAND COST OF UILDING-
TYPE F IMPROVEMENT BUILDING TYPE MOBILITY
New building ❑Single Family ❑New County Resident
❑ ddition ElMulti-Family
Is this structure to serve the residential
❑Alteration
number of units or commercial needs of those employed
❑Hotel,Motel, Dormitory at either the U.S. Nav
❑Repair,replacement number of units V's Trident or
f Indian Island Facilities?
Ei Wrecking
C> Mobile Home
❑Moving (relocation)
❑Other—Specify ❑YES ❑NO
❑Foundation only
OWNERSHIP USE
❑Full-time Residence
❑Private (individual,corporation,
nonprofit institution,etc.) ❑Second Home: Recreation Cabin,etc.
Tv5
❑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 building at industrial plant.
a. Electrical If use of existing building is being changed,enter proposed use.
Cr'''—' b. Plumbing %' I l( / x f V
c. Heating,air conditioning f r /fir r (�`� (� r
_..�
d. Other (elevator,etc.) }�/� lJ
• TOTAL COST OF IMPROVEMENT $ {r J I
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE MENSIONS
(
,-_:,i' ❑Masonry (wall bearing) ❑Public or P •Number of Stories
❑Wood Frame •Total square feet of floor area,
I,ndivi ual (septic t nk,etc.) all floors,based on exterior
CIStructural steel dimensions
T E WATER SUPPLY
❑Reinforced concrete •
Total land area,sq.ft.
/ L�Other—Speci ublic or private company
v )/////j `% may NUMBER OF SPACES
�/ft•Z l. K ❑Individual (well,cistern) PARKING SPACES
,`
PRINCIPAL TYPE OF HEATING FUEL Enclosed
TYPE OF FIREPLACE
❑Gas Outdoors
`t) ❑ •iI RESIDENTIAL BUILDINGS ONLY
`=J �� lectricity Number of bedrooms
El Coal TYPE OF MECHANICAL
lip —Specify Number of {Full
bathrooms
Partial
IV. IDENTIFICATION- .
Name Mailing Address—Number,street,city and State ZIP code Tel.No.
1. 10p yU2—.A Pf 0 ) /3 0K . ?tom ` .-/37/
Owner m '/' /
t -Tte5.
CF(rot624.
YYI` l Le 1 t l
_ .srarP I i A 3.3� �35�
6 { a.'u-e U///.,.,y
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Signature of applicant���� ic� �;g w Address Application at
. 6..frito .- ___
/ A.
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY .—> 11 _
l p�lJ(
JEFFE f CO Y HEALT DEPARTMENT
AAFF145V �fRM E IS UE DATE RECEIPT NUMBER
Jul s , 5-- /C.,.- 110 i 767 C
BU I L N PLANNINC 8 8LW0 DEPTa'e ,, --1 )
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APPROVED
Jul 6 U lc
JEfFERSON COUNTY
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