HomeMy WebLinkAboutBLD1988-00445 BUILDING PERMIT APPLICATION
Jefferson County Buildi epartment• County Courthouse •Port Tow , Wash.98368 • 385-9141
N E '
I. LOCATION: geographic name SW SIDE OF ROAD F
N E f /�
S W FROM INTERSECTION OF ROAD AND L I \ { � , O D
other specific location or landmark:
f5 EGAh DUTN: Q
` .�/ Lot Block Sub isi r'�
0 a 13a)1 Tax Number y<Section Section Township ange
II.TYPE AND COST OF BUILDING-
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
D(J New building ❑Single Family
l/ � ❑New County Resident
❑Addition ❑Multi-Family Is this structure to serve the residential
number of units
❑Alteration 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 ❑NO
❑Foundation only
M e)6A 51,,,s,
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.
//00 a. Electrical If use of existing building is being changed,enter proposed us
b. Plumbing a / �\/( gcp _ K�ze �.:/��/,
oc. Heating,air conditioning ``--�i (1 —I/"``r�rr t
d. Other (elevator,etc.) '
• 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
•Total square feet of floor area,
❑Wood Frame ❑Individual (septic tank,etc.) all floors,based on exterior
ElStructural steel dimensions
TYPE OF WATER SUPPLY❑Reinforced concrete •Total land area,sq.ft.
Other`M—Specif ❑Public or private mpany
��,�_ NUMBER OF OFF-STREET
❑Individual ( I,cistern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF F EPLACE
❑Gas Outdoors ..
❑Oil RESIDE IAL BUILDINGS ONLY
❑Electricity N ber of bedrooms
❑Coal YPE OF MECHANICAL
❑O r—Specify i Number of
Full
bathrooms
Partial
IV. IDENTIFICATION -
Name Mailing Address—Number,street,city and State ZIP code Tel.No.
1. Ec I), 0 , (')(I. l ?c'( 9'?S 7G
Owner
`' �t a. 319
2.
Contractor State License IJo.
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
�Signoure of applicant
Add�r�s/ )�� � Applic lion at
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY V- -
JEFFERSON 0 EALTH EPARTfv1ENT
AFPRPACO PERMIT FEE ISSUE DATE
/OtO� RECEIPT NUMBER
MA 1 �3 , 5 - 3p ( „
d sAi
BU3 0FUIvIY I- f � l� `-�
PIaNNIAG&BLOC LOT
The Printery—Port Townsend
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20
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CDIC*
eae.e. .5-7ze-e-- 6.-"c14777
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APPROVED
MAY 2
JEFFERSON COUNTY
PLANNING&BL G DEPT...„
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