HomeMy WebLinkAboutBLD1988-00449 BUILDING PERMIT APPLICATIO
Jefferson County 8uildfiepartment• County Courthouse •Port Toad, Wash.98368 • S85-9141
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I. LOCATION: geographic name S W SIDE OF ROAD ._ FEET
NE
S W FROM INTERSECTION OF ROAD AND ROAD
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other specific location or landmark: /��IIG� �� C/ 2 �-�//f/1P11S ��
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LEGAL DESCRIPTION: % VV
(____.
r�% �`L:� 7t�cc� �d) `��c c�-
Lot \Block Subdivisi
/704'liCe-4-@'7 g•-• (7 )e cv _...2) 1 .l. '
Number Y.Section Sec ion ownship Range
II.TYPE AND COST OF BUILDING-
TYPE OF IMPROVEMENT,r` DV BUILDING( TYPE MOBILITY
❑New building Single Family ❑New County Resident
❑Addition ❑Multi-Family Is this structure to serve the residential
number of units
Iteration 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
N.. ❑Moving (relocation) ❑Other—Specify ❑YES ❑NO
f , ❑Foundation only
/4e77Csl74/,.0 70 E-,rtrne J
/Roo v.c 64/..
USE
OWNERSHIP
❑Full-time Residence
❑Private (individual,corporation,
nonprofit institution,etc.)
ElSecond Home: Recreation Cabin,etc.
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: 3 ❑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 „ 4) ��
'v —••T pNJ' /..1/1/117(-77f_ EX/.f/7rCj 6-45'/^t
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c. Heating,air conditioning /1/Zs(v (0, 1 tLo�� ,eta..—
d. Other (elevator,etc.) 4/Ye-aue p, �
• TOTAL COST OF IMPROVEMENT $2 /���' /
fir' ((// �t//''�i
III.SELECTED CHARACTERISTICS OF BUILDING -
I I DIMENSIONS
C''' PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL
(
❑Masonry (wall bearing) ❑Public or Private •Number of Stories
',; •Total square feet of floor area,
❑Wood Frame [Individual (septic tank,etc.) all floors,based on exterior
. ❑Structura eel dimensions
%" ❑R ' orced concrete TYPE OF WATER SUPPLY •Total land area,sq.ft.
,_•, - Public or private company X 1' �C��
Other—Specify
�Op`' ❑Individual (well,cistern) NUMBER OF OFF-STREET
s PARKING SPACES
'"? Enclosed
r-.,'"" PRINCIPAL TYPE OF HEATING FUEL
TYPE OF FIREPLACE
El Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY
❑Electricity Number of bedrooms / dr .t�� .4
El Coal TYPE OF MECHANICAL
El Other—Specify
Number of Full �
bathrooms
Partial
IV. IDENTIFICATION - •
Name Mailing Address—Number,street,city and State ZIP code Tel.No.
1. 1 f .)/afrij:v -D6Ris .J K /67 (s41es-f-,E`,ru:? kic, , C'cc, .)e, C'>7Z V97y9os(C4 ? 93i"'7
Owner
2.
Contractor State License No.
I 3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Signature of applicant Address
Application date
(4,%a F X iz-,Ji ,>/z, CCL ., /6 J }/C_..r,.( .)' ,._,--. ,4 `..0 [--e c,j��-Ai C '› ,:'6 (.J'
PLANNING AREA l FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROV BY
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_JEFFERSOI COUNTY HEALTH DEPARTMENT
APPROVED PERMIT- E ISSUE DATE RECEIPT NUMBER
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2 5-14e6 , 3 /S (a/W scR (CI
BUILDING OFFICIAL ��
JFIFIRSON COUNTY !
PLANNING&BLDG DEPT
The Printery —Port Townsend
APONOVta
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