HomeMy WebLinkAboutBLD1988-00400 BUILDING PERMIT APPLICATION
Jefferson County Buildint,, ar+tment• County Courthouse •Port TownsfiWash.98368 • 385-9141
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I. LOCATION: geographic name S W SIDE OF Ft/A D FEET
NE
S W FROM INTERSECTION OF ROAD AND( 4. (— i- ROAD
other specific location or landmark:
,r)
LEGAL D�jS�{�j IPTION:
P(Jp (/�'� Lot Block 5 Subdio /6\..)
Ai
(3,51 D f Tax Number Ys 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
1:]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 ❑YES ❑NO
❑Foundation only
8 IX/2_' /4ani77,1.a
-As" A- 4404'in 1/7414 tQ
USE
OWNERSHIP
N ( � ❑Full-time Residence
❑Private (individual,corporation, ��/� Ool�1v
nonprofit institution,etc.) u �� 1 ❑Second Home: Recreation Cabin,etc.
❑Public (Federal,State or local gov't.) UBC OCCUP4VCY GROUP: cl--3 LI Second Home: Future conversion to
permanent residence
4;‘,.) COST (Omit cents)
Nonresidential— Describe in detail proposed use of buildings,e.g.,food
i • 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 ind stria) plant.
a. Electrical If use of existing building is being cha ged,enter proposed
'`- b. Plumbing f� ( Z U/. //{ e --- �J�/ / ,
e x /l jj" C�l�
/
` c. Heating,air conditioning
d. Other (elevator,etc.)
• TOTAL COST OF IMPROVEMENT $
Y III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE C414 �lA1ENSIONS
T EOFSEWA�
Masonry (wall bearing) •Number of Stories
❑ ❑ ublic or P ' 111
Wood Frame . '� •Total square feet of floor area,
ndivi ual (septic tank)etc.) all floors,based on exterior
❑Structural steel dimensions
❑Reinforced concrete TYPE OF WATER SUPPLY •
Total land area,sq.ft.
El Other—Specify ❑Public or private company �, �{�',
NUMBER OF OFF-STREET
❑Individual (well,cistern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
CI Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY
Electricity Number of bedrooms e. m
❑Coal TYPE OF MECHANICAL
Okh�r Number of
fv///AA'( Full l tz)/Ecam
~gp i 1� ( bathrooms A �
( C1,t Partial
v. IV. IDENTIFICATION -
Name Mailing Address— Number,street,ci and-State ZIP code Tel.No.
1. /y ?V k / ^ , �j /
v Owner ` C �J�v'�v J 7 11}`"`�"' �`C���
:5e3
2.
.... r
Contractor State License No.
CNI 3.
Architect v
The owner of this building and the undersigned agree to conform to all applicable laws.
Signature of applica - Add ss Appl'cation to
./\?
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY 7
e' ® \C-- M P.---_ .-- --
JEFFERSON COUNTY HEALTH DEPARTMENT
APPROVED BY: PERMI E ISSUE DATE RECEIPT NUMBER
3 d5—D 1 q 7
BUILDING OFFICIAL � ,s s,
`fi�U The Printery—Port Townsend
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