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HomeMy WebLinkAboutBLD2004-00014 4143 UILDING PERMIT APPLICASDN MLA04-00014 Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD04-00014 Received Date: 1/9/2004 SITE ADDRESS: 651 S POINT RD PORT LUDLOW, 98365 OWNER: JOHN D CROWELL PHONE: (360)437-4040 CHANDLER CROWELL 651 S PT RD PORT LUDLOW WA 98365 SUBDIVISION: SQUAMISH HARBOR BCH Block: Lot: 24 PARCEL NUMBER: 996600038 Section: 4 Township: 27 N Range: 01 E CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP ADDITION - NEW HEATED SUNROOM TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP ADD MAIN: 400 VALUATION 26,112.00 ADD'L: HEAT TYPE: EEE CODE EDITION: 1997 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: PARCEL TAGS: YES NO BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA Exist: Exist: Wetland Erosion Prop: Prop: Seismic Streams Total: Total: Flood Way Floodplain F&W Landslide Routing Date: /3/6.4 Shoreline Aquifer Forest: Commercial Rural Type Amount Paid Bv: Date: Receipt: Approved/Date Permit $411.45 KAS 01/09/04 62375 Plan Check $267.44 KAS 01/09/04 62375 State Building Code $4.50 KAS 01/09/04 62375 Total: $683.39 • �_ Jefferson Cant.partmnt of City Development �� � o r cd, ( rc R "'' i El Sh lan Street,Pit Townsend WA 88368[3M 371-4450 �_ I APpOk ?5© iPa? 1 .}t t `i Project Description: trc OF C �IVI_U ij':r JEVELOPME%VY i ' Builii1g Type: Project Type: Frame Type: Single Family ❑ New Wood • Garage Attached/Detached [Addition ❑ .Steel ❑ Modular 0 Alteration/Remodel ❑ Concrete . ❑ Commercial 0 Repair ❑ Masonry ❑ Multi-family/#of Units ❑ Demolition ❑ Other ❑ Industrial ❑ Other: Bathrooms:/ Bedrooms: / Type of Sewage Disposal: Type of Heat: Choose one: Existing i�.!S Existing: / ❑ S er ❑ Community System Er-Electricity 0 Oil Proposed: Proposed: E Individual System IC'Voodstove ❑ Propane Total: Tom If no-sewer,fill out the following: ❑ Heat Pump 0"--tonventional ❑ Alternative ❑ Other Permit# SEP Water Supply: ❑ Private well ❑ Two Party Well❑ Public:Name of water system: Square Footage: For Office Use Only Main Floor C> (‘)t I I Consistency Review 4' ,QQ 2ND Floor Base fee L{ 1 1 , ''5- 3rd Floor Plan Check fee—655% a k,i . Ay Htd Basement State Surcharge fee 2'1 5Q Unhtd Basement Subtotal 1 J 1 , 3 9 Garage/Carport Pot Water Review fee y Decks 911/Rd Approach fee r-� 2 )(A'.�inS Commercial TOTAL 13 I . 3 9 Industrial Receipt# CQ W3-1 5 Other Cash/Check# FcD3 Total Valuation: Initials Or c70 Date 1/6)/74ji/ô # Estimated Cost ��Di� If within 200' of the Shoreline, Distance to Bank or Ordinary High Water Mark ft.Bank Height ft. By signing the application form,the applicant/owner attests that the information provided herein is true and correct to the best of their knowledge. Any material falsehood or any omission of a material fact made by the applicant/owner with respect to this application packet may result in this permit being null and void. I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and it's employees,representatives or agents for the purpose of application review and any required later inspections. Access and right of entry to .-applicant's property or structure shall be requested and shall occur during regular business hours. Signature i- - Date: ; OVER H:HOME\PLNCNTR\INFOBLDG\FORMS\BLDpetmitApplication 11-8-01 #11111 \� . - .. »