HomeMy WebLinkAboutBLD1988-00453 FAj1ILDING PERMIT APPLICATION
Jefferson County Building Dep ent• County Courthouse •Port Townsend, it 98368 • 385-9141
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I. LOCATION: geographic name S W SIDE OF R FEET
NE
S W FROM INTERSECTION OF ROAD AND ROAD
other specific location or landmark• A_ h Crn Q C
LEGA DESCRIPTION: 1
a , Lot `--- ock Subdivision
A:.5 %i/�!'' _ ,'":•••';'' Tax Number Y4 Section Section Township Range
. Y• AND COST OF BUI DING-
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
New building ❑Single Family ❑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)
—Specify ❑YES ❑NO
❑Foundation only
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' OWNERSHIP USE
❑Private (individual,corporation, ❑Full-time Residence
(� nonprofit institution,etc.) El Second Home: Recreation Cabin,etc.
�1 � DI Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: ❑Second Home: Future conversion to
permanent residence
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v 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. umbing — /q (
c. Heating, • conditioning l0 9'
d. Other (elevator,et //�// ✓ id
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• TOTAL COST OF IMPROVEMENT $
III.SELECTED CHARACTERISTICS OF BUILDING
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DTSAL Velj
DIMENSIONS
❑Masonry (wall bearing) •Number of Stories
❑Public or Pri •Total square feet of floor area,
❑Wood Frame lndivid al (septic tank, tc.) all floors,based on exterior •
❑Structural steel dimensions
! TYPE OF WATER SUPPLY
J
%- ❑Reinforced concrete •Total land area,sq ft
,j Other—Specif ❑Public or private company
NUMBER OF OFF-STREET
k �l NJ v,a` ,a ❑Individual (well,cistern) PARKING SPACES
^'1 Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY
Electricity Number of bedrooms
❑Coal TYPE OF ANICAL
(�'— Other—Speci Number of Full
(� bathrooms
r'�s ` )l/e _ • Partial
../3 IV. IDENTIFICATION- •
Name Mailing Address—Number,` street,cit State ZIP code Tel.No.
t. ._„ it 1. 0R 0 , / ✓ v J(/ (� 9 . 0 , 07
Owner 1 i k,.....;-,)
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2.
Contractor State License No.
3.
Architect
he owner of this building and the undersigned agree to conform to all applicable laws.
ignature of ap licant CZ
APPIi lion ate
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PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY \
JEFFERSON COUNTY HEALTH DEPARTMENT o� t\ \� .
APPROVED BY: PERMIT FEE ISSUE DATE RECEIPT NUMBER
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BUILDING dANICI4L'98�ij�J,j__)\.,3 Ci< , 3 ,0D . I /&/7S,OD
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JEFFERSON COUNTY The Printery—Port Townsend
PLANNING&BLDG DEPT
APPROVED
,BAN 5 MB �✓��
JEFFERSON COUNTY
PLANNING&stflG DENT
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