HomeMy WebLinkAboutBLD1988-00438IBUILDING PERMIT APPLICATION .
Jefferson County Building Srtment• County Courthouse •Port Townsellash.98368 • 385-9141
N E
I. LOCATION: geographic name S W SIDE OF I /� ROAD �y �® �` FEET
N E 7 ? l./ I d O.Wf C.I�(/�ll� �'S W FROM INTERSECTION OF ROAD AND Cam(/ F{OAD
other specific location or landmark:
P -LEGAL/ DE RIPTION:
'` aX Lot Block Sub3sion 1
36 r Tax Number %Section Sectio Township Range
II. TYPE AND COST OF BUILDING-
TYPE •F IMPROVEMENT BUILDING TYPE MOBILITY
"1 New building ❑Single Family ❑New County Resident
r
❑ %ddition ❑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 LINO
❑Foundation only f)) (J j� c/Y
��- OWNERSHIP USE
❑Full-time Residence
❑Private (individual,corporation, ❑Second Home: Recreation Cabin,etc.
nonprofit institution,etc.)
❑Public (Federal,State or local gov't.) II6C-OCCUPANCY GROUP: / `�/ ❑Second Home: Future conversion to
c;,:
fff permanent residence
, COST (Omit cents) Nonresidential— Describe in detail proposed use of buildings,e.g.,food
N.., • Cost of improvement $ processing plant,machine shop,laundry building at hospital,elementary
1 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 changed,ente proposed uRe.
CT b. Plumbing x -( K ( c 627/, _
c. Heating,air conditioning
d. Other (elevator,etc.)
`�oL • TOTAL COST OF IMPROVEMENT $
.0 ; III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
Masonry (wall bearing) - •Number of Stories
❑ ❑Public or Private
god Frame •Total square feet of floor area,
❑Individual (se. c tank,etc.) all floors,based on exterior
❑ dimensions
cuctural steel
TYPE OF 'TER SUPPLY
❑Reinforced concrete •Total land area,sq.ft. `/✓J
❑Other—Specify blic or private company
NUMBER OF OFF-STREET ;
Individual (well,cistern) PARKING SPACES _,,., .
Enclosed
PRINCIPAL TYPE OF HEATING FUEL -
TYPE OF FIREPLACE
❑Gas Outdoors
❑Oil RESIDF„IJT1AL BUILDINGS ONLY
El Electricity -Number of bedrooms
❑Coal TYPE OF MECHANICAL
Offier—Specify ' Number of Full
- bathrooms
Partial
Y IV. IDENTIFICATION - •
Name Mailing Address— Number,street,city and State Tel.No.
14'CI C IPI\ . 6 -
I
....7, 6eresef f 4/1 ;
•
1-00 If , 7 p 0 d 0I meio ifiCl 3661 ,s-' --
nt�a t Li s N ��
w rt t.-l f�s� 4/6
s
3.
Architect
he owner of this b • ng and the undersigned agree to conform to all applicable laws.
Si rero app is Address lI anon da
S
5....)
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY
JEFFERSON COUNTY HEALTH DEPARTMENT
APPROVED BY: _PERMIT FEE ISSUE DATE
RECEIPT NUMBER
C V. CD5)SO 7 a
BUILDING OFFICIAL Q 3i cE)
The Printery—Port Townsend
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