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HomeMy WebLinkAboutBLD2004-00351 UILDING PERMIT APPLICAIN BRDO-00 51 ev ew Type: i Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD04-00351 Received Date: 5/28/2004 SITE ADDRESS: 141 JACKSON LN PORT LUDLOW, 98365 OWNER: BRADFORD NEWELL PHONE: (360)437-9151 JUDITH NEWELL 141 JACKSON LN PORT LUDLOW WA 98365-9609 SUBDIVISION: PORT LUDLOW NO 2 AREA 3 Block: Lot: 42 PARCEL NUMBER: 990600342 Section: 9 Township: 28 N Range: 01 E CONTRACTOR: WHITEY JOHNSON PHONE: 779-9884 PO BOX 1110 SUQUAMISH WA 98392 Contractor's License WHITEVG159DN Expires 3/15/2005 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION REPLACE DECK-NO CHANGE IN FOOTPRINT - NO MLA REQ'D TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP REP MAIN: VALUATION 16,051.00 ADD'L: HEAT TYPE: CODE EDITION: 1997 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: SETBACK: DECK: 681 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 Routing Date: F&W Landslide 44 V Shoreline Aquifer Forest: Commercial Rural Type Amount Paid Bv: Date: Receipt: Approved/Date Permit $279.25 KAS 05/28/04 64492 APPROVED Plan Check $181.51 KAS 05/28/04 64492 State Building Code $4.50 KAS 05/28/04 64492 JUN -,8 2224 Total: $465.26 Jefferson County Plarsning & Building Department ,„ /AI e sf z ici (SA deifierson��rDepatment of ���v CQ 621 Sheridan S rt Townsend WA perm61) .., '. A SS 8[3601318-44� A� ,.., ,„ „,-_,--t,,...„ App.. , ccitoora .., 00 ,-, Building Type: Project Type: Frame Type: K Single Family ❑ New A Wood ❑ Garage Attached/Detached ❑ Addition ❑ Steel ❑ Modular ❑ Alteration/Remodel ❑ Concrete ❑ Commercial A Repair ❑ Masonry ❑ Multi-family/#of Units ❑ Demolition ❑ Other: ❑ Industrial ❑ Other: Bathrooms: 0 Bedrooms: r-) Type of Sewage Disposal: Type of Heat: Choose one: Existing: Existing: / 'Sewer ❑ Community System ;Q,Electricity ❑ Oil Proposed: Proposed: ❑ Individual System ❑'Woodstove ❑ Propane Total: Total: 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 NI D In�Daciff 2ND Floor Base fee a 7 9 3rd Floor Plan Check fee 12.r • S 1 Htd Basement State Surcharge fee Li- S° Unhtd Basement Subtotal Li C Jam• 2� Garage/Carport Pot Water Review fee Decks (,? 5/ / 'tU 05i - `1) 911/Rd Approach fee Q1((S Commercial TOTAL Si�p5 so?JO Industrial Receipt# &e C '9 ? Other Cash/Check# Initials y Date d Estimated Cost: 1 ::7, L(/J 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 andjight 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 the ap cant's property or structure shall be requested and shall occur during regular business hours. 1 Signature: "AA__tJ.2: --,-4-, , Date: 320 ©� OVER ► MAY ??0 /2 004 G:\PetmitCenter\FORMS\BLDG FORMS\BLDPertnit Application. Ol , 0 • BUILDING PERMIT Jefferson County m 621 SheridanDepart Street, Portentof TownsendCommunity, WADevelopment 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD04-00351 Received Date 05/28/2004 SITE ADDRESS: 141 JACKSON LN Issue Date 06/8/2004 PORT LUDLOW, 98365 APPLICANT: BRADFORD NEWELL PHONE: (360)437-9151 JUDITH NEWELL 141 JACKSON LN PORT LUDLOW WA 98365-9609 SUBDIVISION: PORT LUDLOW NO 2 AREA 3 Block: Lot: 42 PARCEL NUMBER: 990600342 Section: 9 Township: 28 N Range: 01 E CONTRACTOR: WHITEY JOHNSON PHONE: 779-9884 PO BOX 1110 SUQUAMISH WA 98392 Contractor's License: WHITEVG159DN Expires: 03/15/2005 PROJECT DESCRIPTION: REPLACE DECK-NO CHANGE IN FOOTPRINT-NO MLA REQ'D REQUIRED INSPECTIONS: L] SETBACKS: ek 0.43/0‘‘ UFFER: [ J' Footing: ,Ok �� �./#--4,3‘.1 bons [ ] Foundation: [ ] Stormwater FINAL Approval: [ ] Underground Plumbing: [ ] Underground Insulation: [ ] Shear Wall : [4j Framing: OK !2/3/ ''',-- f 1 Plumbing: [ ] Propane Tank/ Lines: [ ] Insulation: 1 Sheetrock: _ [ ] Septic Sytem Final Approval: 1 Road Approach Final Approval: [ ] Zoning Final Approval: 1,4f Final/Occupancy Approval: dX /L/�/69 ' HEALTH DEPARTMENT AND PUBLIC WORKS 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 I:\F_BLD_Permit_Bu ildng.rpt 10/29/19 S l A A. i \C" d '.''.'''''','„_:, c , . .',__ \':. .7,,,,:".:,-- IC WIr61-10D4.!i.,!.,'1'1iI!! 4-._,1,4.;1l,!1i!',441PS'A°43ii-.:Ti.;:1'.,(.-•'c1•k-\1L-C h l 0 ,2q %' S.l)D,i,1! • h ::oD:—1()11 1 .• J, , ,o ' s o 1 I ' cLJ PERMIT # ULD 04 _ 351 \,,A.. - JEfF ERSON COUNTY NCO • . ,Z9 '/°1 MAY 2 8 2004