HomeMy WebLinkAboutBLD2004-00388 MLA04-00346
BUILDING PERMIT APPLICPION Review Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00388 Received Date: 6/14/2004
SITE ADDRESS: 2522 E MARROWSTONE RD
NORDLAND, 98358
OWNER: ROBERT BRASIER PHONE: (360)379-1075
MARILYN M BRASIER
1821 E MARROWSTONE RD
NORDLAND WA 98358-9682
SUBDIVISION: NORDLAND BLK 1 Block: Lot: T 83
PARCEL NUMBER: 976200102 Section: 33 Township: 30 N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI' NEW SFR W/ATTACHED GARAGE & DECK(S)
ALSO PROPANE TANK
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 1,804
VALUATION 209,374.00 ADD'L: HEAT TYPE: HTP
CODE EDITION: 1997 HEAT BASE: 55 HEAT TYPE: PRO
OCCUPANCY: R-3 UNHEATED: 1,085 #OF STORIES:
OCCUPANCY:
OTHER:
CONST TYPE: 5N SHORELINE:
CONST TYPE: GARAGE: 606 SETBACK: 68
DECK: 556 BANK HEIGHT: 70
SEWAGE DISPOSAL: ALT
WATER SYSTEM: PWELL PARCEL TAGS: YES NO
BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA
Exist: Exist: Wetland Erosion
Prop: 3 Prop: 3 Seismic Streams
Total: 3 Total: 3 Flood Way Floodplain
Routing Date: F&W Landslide(( '�/��-f c1:e) Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $566.76 KAS 06/14/04 64532
Plan Check $1,046.34 KAS 06/14/04 64532
State Building Code $4.50 KAS 06/14/04 64532
Total: $1,617.60
I
,� ��„� o Jefferson Iepartmont of Commit,'pavement
stir 621 Sheridan S Town :ud WA 88388(3801 370-4450
permot 0 0
,cely.lion
4. ''y App
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1
Byilding Type: !" Project Type: Frame Type:
Single Family 1 V New FJ/Wood
❑ Garage Attached/Detached t I L "❑ Addition ❑ Steel
1
❑ Modular JUN 4 20°4 't El Alteration/Remodel ❑ Concrete
❑ Commercial Li Repair ❑ Masonry
❑ Multi-family/#of Units 1-- Jr l t r'h 0,' GGJNTY i Demolition
❑ Industrial ❑ Other:
t'T,TT. 01* CC°'__ {ti p.c---- ---.
❑ Other: ,.0 "
Bathrooms: Bedrooms: Type of Sewage Disposal: Type of Heat:
Choose one:
Existing: Existing: ❑ Sewer ❑ Community System Electricity ❑ Oil
Proposed: Proposed: Individual System ❑ Woodstove VPropane
Total: 3 Total: If not sewer,fill out the following: L'Heat Pump
❑ Conventional ❑ Alternative El Other
1 � pµ lrtt /""Permit# SEP Q/ 00 1=1)
Water Supply:
VPrivate well ❑ Two Party Well❑ Public:Name of water system:
Square Footage: Office Use J ,,"Z For Office Use Onlyaki i��Q. - Duc
Main Floor /pjo1' `\\ \. Consistency Review �— 1 C� • ��
2ND Floor Base fee p °44 43 LO.
a
3rd lFlo/or i 4 — Plan Check fee t3 •F . • j i' irj•
H?d Ba nt (4 0OrT \`'~ State Surcharge fee r♦
Unhtd Basement
Subtotal t 1 _ ��j 'b g„`� jll r �1
Garage/Carport (�01� \ �` �o be . fo 0 C�+�Z� <
Pot Water Review fee
i \ D\«�- %Decks 1 5 5911/Rd Approach fee ff I eV
Commercial TOTAL o b
-Industrial Receipt# it CsfptlJR .
Other Cash/Check# A. 6
ji`IC.ift.,9-- AC:t2- Initialsf.{�5r/�t1� Dili, `- 7 O l
Date
Estimated Cost: I r�(07�000 J
If within 200' of the Shoreline,
Distance to Bank or Ordinary High Water Mark 7D ft.Bank Height 707. ti Jft.
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 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, e applicant's proper structure shall be requested and shall occur during regular business hours.
C `'
Signature: ' .� ., 4? ./ - L Date: 6,/o D I-
OVER
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G:\PermitCenter\FORMS\BLDG FORMS\BLDPermit Application.doc 01/08/2004
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