HomeMy WebLinkAboutBLD1989-00017 BUILDING PERMIT APPLICATION ' •
Jefferson County Building 4110 rtment• County Courthouse •Port Townserigash.98368 • 385-9141
N E
I. LOCATION: geographic name S W SIDE pF ROAAD FEET
S W FROM INTERSECTION OF „ ROAD AND
other specific location or landmark:
LEGAL DESCRIPTION:
Lot Bloc Subdivision
9,2 I 3+Ooq 2 SE S� Less 3z n ti
Tax Number %S lion r/t{)Section Township Range
II.TYPE AND COST OF BUILDING-
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
' New tluildrrrcf MOD(L 1Um� ❑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) ❑Other—Specify ❑YES ❑NO
❑Foundation only
CL
rd sue)
USE
OWNERSHIP
❑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 /I'( �/
c. Heating,air conditioning „�
d. Other (elevator,etc.) L , /79:
• TOTAL COST OF IMPROVEMENT $
III.SELECTED CHARACTERISTICS OF BUILDING
PRINCIPAL TYPE OF FRAME__- TYPE OF SEWAGE DISPOSAL
DIMENSIONS
•Number of Stories
0Masonry (wall bearing)- ❑Public or Private
j' •Total square feet of floor area,
❑Wood Frame- individual (septic tank,etc.) all floors,based on exterior
dimensions I� 70
❑Structural"steel
CI Reinforced concrete TYPE OF WATER SUPPLY •Total land area,sq.ft.
❑Other—Specify 14-
❑Public or private company �'��
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 3
❑Coal TYPE OF MECHANICAL
❑Other—Specify Number of Full
bathrooms
• Partial
IV. IDENTIFICATION-
Name Mailing Address—Number,street,city and State ZIP code Tel.No.
1. \.6►'YI.Q-.S I.U6(gj I -7 o -[ c51"l.l✓_12_ d a.J J P. L- �,6;z5
Owner -Fe sf.e ' /
2.
Contractor State License No.
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Signature of applicant Add s Applicatio dat
•....,_ IA `-` liVe
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY
_ 1C LIS72-, y 2d'4,
JEFFERSO C NTY HE TH DEPARTMENT
APPROVED B PERMIT FEE ISSUE DATE RECEIPT NUMBER
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BUILDING OF�FICIAL98g
IrFgRsoN COUNT y ® _ _ 0 /� /
PLANNING So SLOG DEPT -- O tTh• • —Port Townsend ! / /�
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Jefferson County Planning and Building Department
Courthouse, 3rd Floor
PO Box 1220
Port Tnwnsend, WA 98388
208-385-9141
PFRMTT # -RT,i?89-00 1 7 nATF. TSSUR€i. -04 i 28/89
STTF ADDRFSS- SHTNF RD
:PORT TJ DT,OW. WA 98385
OWNER .TAMES TRSTFR P ONE, -
MAT€,TNC A DR : 1721 SHTNF Rn
:PORT LUDLOW WA 98365
CONTRACTOR. . -NO CONTRACTOR PHONE.:
MAILING A€}7R -
CONTR. LTC #- F.XPTRAT T ON i)ATR
PARCF€, NO. . . - 821 344009
€,FOA€, T)FSC. . - STR 34-28-01 RWM. TAX #
LOT , BLOCK
1 SCRTPTT0N OF TMPROVFMFNT- mobile home instal i at i on it L ��
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( ) Footing/Setbacks (Shoreline Sethar:k) /Mnh i l e Hnme Blocking:
( ) Foundation -
•
( ) Underground Plumbing/Underground Tnsulatinn -
( ) Framing/Plumbing/Chimney:
( ) Tnsulatinn-
( ) Sheetrnr k -
( ) Sewage llispoSai System Final -
( ) Final/Occupancy Approval : )
CA€.T, 385-91 41 24 HOURS TN ADVANCE TO SCFRDUi.F. INSPECTIONS.
Office Hours 9 a .m. to 5 p.m.
Tnsneotor ' s Hours 9 - 10 a .m.
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APPROVED
APR 2 8 t989 `' '1G° N!
JEFFERSON COUNTY
PLANNING&BLDG DEPT
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