HomeMy WebLinkAboutBLD1988-00424 UILDING PERMIT APPLICATION '
Jefferson County Building D tment• County Courthouse •Port Townsentelsh.98368 • 385-9141
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I. LOCATION: geographic name S W SIDE OF ROAD FEET
NE
S W FROM INTERSECTION OF ROAD AND 7 -rc/r10 GLt_ ROAD
other specific location or landmark:(
LEGAL E$�RIPTION: �``Q (-
Lot Block' Sub 'vi ion
r,...,,,...,
/ del Tax Number
Rio /.Section Section Township i‘taiie)
II. TYPE AND COST OF BUILDING-
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
/%
d%r ew building 1 Single Family
❑New County Resident
al Addition ❑ lb-Family Is this structure to serve the residential
❑Alteration
number of units or commercial needs of those employed
❑Repair,replacement ElHotel,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
- USE
❑Full-time Residence
❑Private (individual,corporation,
nonprofit institution,etc.) �j ❑Second Home: Recreation Cabin,etc.
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: i ❑Second Home: Future conversion to
NCOST permanent residence
(Omit cents) Nonresidential— Describe in detail proposed use of buildings,e.g.,food
cNCT • 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 p oposed use.
b. Plumbing �/( 5-6 67 � j Q(e 0
c. Heating,air conditioning
�J d. Other (elevator,etc.)
• TOTAL COST OF IMPROVEMENT $
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DI_S#
•
ENSIGNS
❑Masonry (wall bearing) ❑Public or Private--rr ci •Number of Stories
Wood Frame f t�J) •Total square feet of floor area,
( Qy lndivid septic tank, tc. all floors,based on exterior
Structural steel `/ �, dimensions
•
TYPE OF WATER SUPPLY Total land area,sq.ft.
❑Reinforced concrete
❑Other—Specify ublic or private company
Individual (well,cistern) NUMBER OF OFF-STREET
PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY
Electricity Number of bedrooms 3 �Xmikl
❑Coal TYPE OF MECHANICAL
thz-Sp city Number of Full
fj�� bathrooms
Partial
IV. IDENTIFICATION - .
me Mailing Address—Number,street,city and State ZIP code Tel.No.
1. 60Z. S 7cre, ' 37 —i:NO
Owner j__,�
l
2. �.
Contractor State License No. I
3.
Architect
he owner of this building and the undersigned agree to conform to all applicable laws.
i Signature of applica fI Address A caatttiion ate
7
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY N
JEFFER"O . •• HEA TH DEPARTMENT
APPROVE :-1.P,' (Q ? . P_ERMI E I SUE DATE RECEIPT NUMBER
t� s
A i , 3\j,,1'88 4,414., 3, 51-)
1301 ... q ?S
BUILDING OBEg1 W `-
PLANNING R R OG (�C� s�
LOG DEPT
The Printery—Port Townsend
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