HomeMy WebLinkAboutBLD1988-00435 Ol1ILDING PERMIT APPLICATION
Jefferson County Building Department• County Courthouse •Port Townsend, ..ash.98368 • 385-9141
N E
I. LOCATION: geographic name S W SIDE OF ROAD
/� (� FEET
S W FROM INTERSECTION OF ROAD AND C2g 3 FiW (�I 0 (9ROAD
I)
other specific location or landmark:
LEGAL DESCRIPTION:
1 e- --at Lot Block Subdivision
Tax Number Y<Section Section Township Range
II. TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
chew 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
❑Repair,replacement El Hotel,Motel, Dormitory at either the U.S.Navy's Trident or
�_ number of units Indian Island Facilities?
❑Wrecking
(Mobile Home
❑Moving (relocation) �� `Ot
❑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: �� ❑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.
b b. Plumbing ` c9 �XCo 0
c. Heating,air conditioning / 1,e
� E "
d. Other (elevator,etc.) t ! \ C may) sz
ftl,° • TOTAL COST OFIMPROVEMENT $ �X ��� J e\\C�!l�C•��* 1�
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
❑Masonry (wall bearing) •Number of Stories rJ
❑ •Public or Private
•Total square feet of floor area,
❑Wood Frame .Lndividual septic tan ,etc.) all floors,based on exterior
❑Structural steel dimensions
lug TYPEER SUPPLY Total land area,sq.ft.
Reinforced concrete •
Pt --- private company
Other—Speci NUMBER OF OFF-STREET
t , 0,�.O,n�� ❑Individual (well,cistern) PARKING SPACES
wY I�vv 333��i1��IH i Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY
Electricity Number of bedrooms
'+A ❑Coal TYPE OF MECHANICAL
Other—Specify Number of Full
GV/ I0 bathrooms
Partial
IV. IDENTIFICATION-
•
Name } C� (
1. (—�f Mailing Address— Number,street,city and State ZIP code Tel.No.
Owner t& �T,CQ , — CAS V f�Li / g6 Se - CosoX
LuCi...JL
2.
Contractor State License IJo.
.
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
ignatyre of applicant Add ss qic )ati to
�
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY
/� i G--- c5Y ,.a•—
JEFFER,.ON COUNTY HEALT DEPARTMENT
APAR I VO V v PERMIT FEE ISS E DATE
' t V T
.-- 731 0 0RECE I3'T NUMBER
APR 11118 3 , 5--c) V // Jc 07
BUILDING OFFICIAL i �J v
JEFFERSON COUNTY
F'LANNINU&R OG DEPT
The Printery—Port Townsend
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