HomeMy WebLinkAboutBLD1988-00442 BUILDING PERMIT APPLICATION
Jefferson County Buildir.partment• Cou ity Coai-thouse • Port Towns, Wash.98368 • 385-9141
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I. LOCATION: geographic name S W SIDE OF ROAD FEET
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�. S W FROM INTERSECTION OF ROAD AND 'h; C' (:)(Ll Hoc L C (",•_-__ LNC. ROAD
other specific location or landmark: '1
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LEGAL DESCRIPTION: " rt i I ocJc O t L I ci o e
~'' P�-n ,6 Lot Block
t „' Subdivision \ / } j� /f
m ' iif l��C .r+b L X 4"6
I +:�f c° Tax Number %Section Section Township Range
II.TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
New building ❑Single Family ❑New County Resident
t El Addition ❑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 / obile Home
❑Moving (relocation) /❑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. Plumbing 7{ C > J4 j CAC
I l `.-) } f l( ` C
c. Heating,air conditioning � R
d. Other (elevator,etc) `\'`=/P `...9.-
• TOTAL COST OF IMPROVEMENT $
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
ElMasonry •(wall bearing) •Number of Stories
❑Public or Private
CNJ ❑Wood Frame i •Total square feet of floor area,
ndividual (septic tank,etc.) all floors,based on exterior
❑Structural steel / dimensions
.,...�_ TYPE OF WATER SUPPLY Total land area,sq.ft.
❑Reinforced concrete •
` Public or private company
Other—Specify
NUMBER OF OFF-STREET
VO, l', ( ( l i ( C ❑Individual (well,cistern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY -1
Electricity Number of bedrooms --c
C.' '/❑Coal TYPE OF MECHANICAL
a( Number of Full L
❑Other—Specify
bathrooms
Partial
IV. IDENTIFICATION -
Name Mailing Address—Number,street,city and State ZIP code Tel.No.
f
t ('� 5 (►���r�� i f y ``_ t A,�; ^1�� �, q (, — � c->
Owner
2.
Contractor "---,\ SY2te License No.
3.
Architect s.
The owner of this building and the undersigned agree to conform to all applicable laws.
N\A„....Sign of applicant / Address Application date
. C.z ._ rim o7 8
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PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY
JEFFERSON COUNTY HEALTH DEPARTMENT
APPROVED BY: PERMIT FEE ISSUE DATE RECEIPT NUMBER
/a"7/ 'Sq 35
BUILDING OFFICIAL 5--c)
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The Printery—Port Townsend