HomeMy WebLinkAboutBLD1988-00439 BUILDING PERMIT APPLICATION •
Jefferson County Building Depa.nt• County Courthouse • Port Townsend, 1098368 • 385-9141
N E
I. LOCATION: geographic name S W SIDE OF" ROAD } F�EET
N E
S W FROM INTERSECTION OF ROAD AND Fe .-,�171IjA , ^l A4K.
other specific location or landmark:
LEGAL DESCRIPTION: (0 0
r8 d1 6 tt i1 Lot Block Subdi ' i '
9V 2 (1.000�� �t
Tax Number '/.Section Sec on ownsl�ip Range
II. TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
New 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
❑Hotel,Motel, Dormitory at either the U.S.Navy's Trident or
❑Repair,replacement number of units
Indian Island Facilities?
❑Wrecking ❑Mobile Home
❑Moving (relocation) 154 Other—Specify ❑YES ❑NO
❑Foundation only LA bet-ikta-kPj
USE
OWNERSHIP
❑Full-time Residence
❑Private (individual,corporation, T" ❑Second Home: Recreation Cabin,etc.
nonprofit institution,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. Plumbing / / 5 /p ,�%/)
bait(c. Heating,air conditioning7 S2� � G CCC�
d. Other (elevator,etc.) .f.,
CT 000
CT • TOTAL COST OF IMPROVEMENT $
-"-- III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS ��
Masonry (wall bearing) •Number of Stories
❑�� ❑Public or Private •Total square feet of floor area,
��GVood Frame ��ndivid (septic tank,a c.) all floors,based on exterior
7❑Structural steel 77 dimensions
❑Reinforced concrete TYPETE PLYe2 •Total land area,sq.ft.
ubli r private compar
❑Other—Specify NUMBER OF OFF-STREET
❑Individual (well,cistern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
❑Oil _ RESIDENTIAL BUILDINGS ONLY
Electricity Number of bedrooms
❑Coal TYPE OF MECHANICAL ,
ttier—SPeci
(f
Number of Full
l hei bathrooms
Partial
6. IV. IDENTIFICATION - j
Name V Mailing Addressss—Number,street,cit and State ZIP code Tel.No.
1. 1'�Uw u rr� l j�/ /p.c_� G c�cpt / 9� —
Owner
PTF 17,3
2. S., 4.1
Contractor State License No.
/..:-.-,
3.
Architect �/
visThe owner o 'this building and the undgned agree to conform to all applicable laws.
~
Signal re applicant Addres A a io a
4- ,t51 tc -C-'ll ''''- (---- Cei-71\--A— c- / 4
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROV D BY \ ikes- b IN aS, _
�•a.,0 O 1C i)62-4-7\
3' s y i s be - Q aa
JE F R,Of A•1+1•/ellk HE' T DEPARTIvMEIVT CJ (fa'
AP•- • , :: P� �; PERMIT FEE ISSUE DATE RECEIPT NUMBER
i + ••A. WI,sD
! 198; miala ..5-P. Li/ 7,),. 7
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