HomeMy WebLinkAboutBLD1988-00415 UILDING PERMIT APPLICATION
Jefferson County Building Al r ftment• County Courthouse •Port Townsen• .as 98368 • 385-9141
N E
I. LOCATION: geographic name S W SIDE OF ROAD �F,EET
N E } h �`�
S W FROM INTERSECTION OF , ROAD AND T7 / 1 f?o- -1-~ ,/,r/r-'l V1,-i'(„KOAD
other specific location or landmark: 1 riAi CA, .40(
GAL DE RIPTION:
E ^0 -��
Lot Bloc Subdivision
( O I(e( J C
7 Tax Number Y<Section Secti n / Township Range
II.TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
w building New
❑Single Family
dition ❑New County Resident
❑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)
j�(Other-Specify ❑YES ❑NO
❑Foundation only \
OWNERSHIP USE
❑Full-time Residence
❑Private (individual,corporation,
nonprofit institution,etc.) �� / ❑Second Home: Recreation Cabin,etc.
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP:-L1 —L._ ❑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 indu ial plant.
a. Electrical If use of existing building is being changed,enter pro osed use.
' b. Plumbing (-94 y'(---/V ;1/ V1 —C
,.�.+�- c. Heating,air conditioning
u"' d. Other (elevator,etc.) 7/ -fil
0 • TOTAL COST OF IMPROVEMENT $
III.SELECTED CHARACTERISTICS OF BUILDING -
k
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE1 SST• ��1 ENSIGNS
� 3y ❑ asonry (wall bearing) f •Number of Stories
❑Public or Private
.... �, •Total square feet of floor area,
Wood Frame Individual eptic tan etc.) all floors,based on exterior_
Structural steel dimensions
TYPE OF WATER SUPPLY Total land area,s �
❑Reinforced concrete •
❑Other-Specify ❑Public or private company
NUMBER OF OFF-STREET
❑Individual (well,cistern) PARKING SPACES
PRINCIPAL TYPE OF HEATING FUEL Enclosed
TYPE OF FIREPLACE
❑Gas Outdoors
❑Oil
RESIDENTIAL BUILDINGS ONLY
❑Electricity____/ - Number of bedrooms
❑Coal,.! TYPE OF MECHANICAL
/ ether-Specify Number of Full
bathrooms
Partial
IV. IDENTIFICATION-
•
Name Mailing Address- Number,street,city and State ZIP code Tel.No.
. ,A,,c,.(--ems , `—/ t cD° - . -r,_, 7/N-r.�.>`k KOZ /9() --
Owner
b is 0 /\} 6 q/c-27
2. c ',
Contractor State License No.
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Si ature of applicant Add ss ..7Apy dat�
7\-tt'i 4..."/IZ-*--1 4J!' 4.11.;',“-4...--7,-,..,- C
/
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY , /
rY Ls-Ole_-4J..�..,
JEFFERSON COU Y HEALTH DEPARTMENT
PPRO�VEFDPBY: PERMIT FEE OO
' ISSUE I RECEIPT NUMBER
® l( 7`
DING OFFICIAL
J� 5(q(41:,,
PLANNING&BLDG DEFT
The Printery-Port Townsend
— nuiyED
NO g 9196 a $2444 e.7- ° 1-%6_,,,
JEffEPLANNING&N COUNTY y
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