HomeMy WebLinkAboutBLD2004-00029 0 BUILDING PERMIT APPLIC-ION BRD98-00 42
eview Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00029 Received Date: 1/15/2004
SITE ADDRESS: 164 COUGAR RIDGE RD
PORT TOWNSEND, 98368
OWNER: ROBERT HINTON PHONE: (360) 379-7799
164 COUGAR RIDGE
PORT TOWNSEND WA 98368
SUBDIVISION: PIONEER ACRES Block: Lot: 5
PARCEL NUMBER: 001175005 Section: 17 Township: 30 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP NO MLA REQ -ADDED LOFT AREA USED AS REC ROOM
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP ALT MAIN:
VALUATION 12,730.00 ADD'L: HEAT TYPE: PRO
CODE EDITION: 1997 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY:
CONST TYPE: OGARAGE: 195 SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM: PWELL PARCEL TAGS: YES NO
BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA
Exist: Exist: Wetland Erosion
Prop: Prop: Seismic Streams
Total: Total: Flood Way Floodplain
Routing Date: i F&W
I
/0(01( Shoreline Landslide
Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Pp d/ jt
A VVy E r,
Permit $223.25 KAS 01/15/04 62420
Plan Check $145.11 KAS 01/15/04 62420 JAN 2 8 2004
State Building Code $4.50 KAS 01/15/04 62420
Total: $372.86 Jefferson County Plonn'p'.i
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Building Depar i
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• Jefferson 1 I whited of Conviviality" Development
°� 6213herman Street,i I Townes WA 11=6813601378-4450
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Building Type: 8 Project Type: Frame Type:
Single Family a ❑ New >e Wood
❑ Garage Attached/Detached ❑ Addition ❑ Steel
CIModular tC7 Alteration/Remodel ❑ Concrete
❑ Commercial i ... ❑ Repair ❑ Masonry
❑ Multi-family/#of Units ❑ Demolition ❑ Other:
❑ Industrial 1
❑ Other:
Bathrooms: Bedrooms: Type of Sewage Disposal: Type of Heat:
Choose one:
Existing: R- Existing: t ❑ Sewer ❑ Community System ❑ Electricity ❑ Oil
Proposed: (g Proposed: 6 Niz'Individual System ❑ Woodstove ,$j`Propane
Total: 2,.. Total: —I— If not sewer,fill out the following: ❑ Heat Pump
❑ Conventional %Alternative ❑ Other
Permit# SEP
Water Supply:
Private well ❑ Two Party Well❑ Public:Name of water system:
Square Footage: Office Use For Office Use Only
Main Floor Consistency Review 7
2ND Floor Base fee ZZ 3. i j
3rd Floor Plan Check fee I L /5)/ • 1 1
Htd Basement State Surcharge fee 'T Sb
Unhtd Basement Subtotal 3 70?. & Y'
Garage/Carport Pot Water Review fee
Decks _ \` 911/Rd Approach fee 1 /
Di1
Commercial , TOTAL 3r �7c ' 1®
Industrial ' / \tl Receipt# (a a i a o
Other i C15 \ll Cash/Check#
Initials
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L►,‘ Date
Estimated Cost: ``
If within 200' of the Shoreline,
Distance to Bank or Ordinary High Water Mark L1 (-A 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 attomey'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 o provide acre_ nd 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 rig of e to the app 's propertyor structure shall be requested and shall occur during regular business hours.
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Signature ` \ Date t— I IA---C3
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G:\PcrmitCenter\FORMS\BLDG FORMS\BLDPermit Application.doc 01/08/2004
410
BUILDING PERMIT 41,
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD04-00029 Received Date 01/15/2004
SITE ADDRESS: 164 COUGAR RIDGE RD Issue Date 01/28/2004
PORT TOWNSEND, 98368
APPLICANT: ROBERT HINTON PHONE: (360)379-7799
164 COUGAR RIDGE
PORT TOWNSEND WA 98368
SUBDIVISION: PIONEER ACRES Block: Lot: 5
PARCEL NUMBER: 001175005 Section: 17 Township: 30 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
LOAN LENDER/
BOND HOLDER:
PROJECT DESCRIPTION: NO MLA REQ -ADDED LOFT AREA USED AS REC ROOM
REQUIRED INSPECTIONS:
[ ] 'F_TBACKS:
[ ] UFFER:
[ ] Footing:
[ ] Foundation:
[ ] Underground Plumbing:
[ ] Underground Insulation:
[ ] Shear Wall :
[ ] Framing:
f 1 Plumbing:
[ ] Propane Tank/ Lines:
[ ] Insulation:
( 1 Sheetrock:
[ ] Septic Sytem Final Approval:
f 1 Zoning Final Approval:
Final/Occupancy Approval: /-yo-oy
HEALT DEPARTMENT APPROVAL REQUIRED PRIOR TO FINAL INSPECTION
THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED
BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS.
Office Hours 9:00 a.m. -4:30 p.m.
HOT LINE AVAILABLE 24 HOURS A DAY
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