HomeMy WebLinkAboutBLD1988-00413 m
UILDING PERMIT APPLICATION
Jefferson County Building rti
tment• County Courthouse • Port Townsenlish.98368 • 385-9141
N E
I. LOCATION: geographic name S W SIDE OF ROAD
NE
S W FROM INTERSECTION OF ROAD AND 0 f "ID A! ROAD
other specific location or landmark: X / i\.v /t
L_E�ALn DE,$CR TION: e 1
(, Lot Block Subdivision
970 YO O 1 Tax Number Y<Section Section Township Range
II. TYPE AND COST OF BUILDING-
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
building Single Family ❑New County Resident
"g:New
❑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 ❑YES ❑NO
❑Foundation only
OWNERSHIP US€/+
///��Private (individual,corporation, / ;1 Full-time Residence
�nonprofit institution,etc.) ❑Second Home: Recreation Cabin,etc.
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: ❑Second Home: Future conversion to
permanent residence
C,i,) 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
__ a 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 i y1`-I T W I C.0 e S
c. Heating,air conditioning V - °6—
d. Other (elevator,etc.) `Q
• TOTAL COST OF IMPROVEMENT $
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE •F SEWAGE DISPOSAL DIMENSIONS
- ❑Masonry (wall bearing) `Public or Private •Number of Stories
Wood Frame •Total square feet of floor area,
❑Individual (septic tank,etc.) all floors,based on exterior �y �—�/
1 ❑Structural steel dimensions ` O_� (��
❑Reinforced concrete TYPE OF WATER SUPPLY ff� /`-'
.., J Public or private company •Total land area,sq.ft. L��+ ,
s ❑Other—Specify O 1 7 .�"
❑Individual (well,cistern)
NUMBER OF OFF-STREET
`� PARKING SPACES
PRINCIPAL TYPE OF HEATING FUEL Enclosed
TYPE OF FIREPLACE
❑Gas Outdoors
r
❑Oil ,4/ /¢ ( RESIDENTIAL BUILDINGS ONLY
Electricity Number of bedrooms
El 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.
1. -PZ W rr 5 . 5-C/r) Vii) CPutf- 07\-eAA6 I
Owner
Pt _
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onac State License No. I t_ ..
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Architect
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ToNiner of thi uilding and ersigned agree to conform to all applicable laws.
fS gnaturfi of a icent�--- " Address
C � Application datef
I �O - . - sy,.�j- nc
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY /
--. — 4:3/C."Ar."-- /7:0)7 ..,rC....VCA..-
JEFFERc' COUNTY HEALTH DEPARTMENT
APPRpED Y: PERMIT IS UE DATE RECEIPT NUMBER
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BUILDING O F Cl/48 IS f Fa
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PLANNING&BLDG Der he rintery—Port Townsend
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