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Home My WebLink AboutBLD2004-00507 0 MILDING PERMIT APPLIATIS BLD04-00507 Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD04-00507 Received Date: 8/3/2004 SITE ADDRESS: 1241 E LUDLOW RIDGE RD PORT LUDLOW, 98365 OWNER: PAUL ROVNER PHONE: (360)437-8194 ROBERTA ROVNER, TRUSTEES 1241 E LUDLOW RIDGE RD PORT LUDLOW WA 98365-9534 SUBDIVISION: Block: Lot: PARCEL NUMBER: 821103005 Section: 10 Township: 28 N Range: 01 E CONTRACTOR: LITTLE & LITTLE CONSTRUCTION PHONE: (360)385-5606 2009 4TH STREET PORT TOWNSEND WA 98368 Contractor's License LITTLLC157C5S Expires 2/18/2005 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION INTERIOR REMODEL - NO MLA REQ TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP ALT MAIN: 0 VALUATION 3,700.00 ADD'L: 0 HEAT TYPE: CODE EDITION: 2003 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: PARCEL TAGS: YES NO BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA Exist: 3 Exist: 4 Wetland Erosion Prop: Prop: Seismic Streams Total: 3 Total: 4 Flood Way Floodplain 7Routing Date: r, / �) fc-- F&W Landslide 6 7 Shoreline Aquifer Forest: Commercial Rural Type Amount Paid Bv: Date: Receipt: 1 I PRO / E Permit $97.25 KAS 08/03/04 66706 � r ("1�J �/ Plan Check $63.21 KAS 08/03/04 66706 AUG 2 5 2004 State Building Code $4.50 KAS 08/03/04 66706 Total: $164.96 Jefferson County Planning & Building Department Cc r , , K C • • BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD04-00507 Received Date 08/3/2004 SITE ADDRESS: 1241 E LUDLOW RIDGE RD Issue Date 08/25/2004 PORT LUDLOW, 98365 APPLICANT: PAUL ROVNER PHONE: (360) 437-8194 ROBERTA ROVNER, TRUSTEES 1241 E LUDLOW RIDGE RD PORT LUDLOW WA 98365-9534 SUBDIVISION: Block: Lot: PARCEL NUMBER: 821103005 Section: 10 Township: 28 N Range: 01 E CONTRACTOR: LITTLE & LITTLE CONSTRUCTION PHONE: (360)385-5606 2009 4TH STREET PORT TOWNSEND WA 98368 Contractor's License: LITTLLC157C5 Expires: 2/18/2005 PROJECT DESCRIPTION: INTERIOR REMODEL- NO MLA REQ REQUIRED INSPECTIONS: [ ] SETBACKS: _ [ ] UFFER: [ ] Footing: [ ] Foundation: [ ] Stormwater FINAL Approval: [ ] Underground Plumbing: [ ] Underground Insulation: [ ] Shear Wall : [ ] Framing: dk [O/Sl , f 1 Plumbing: [[ [ ] Propane Tank/Lines: [ ] Insulation: f 1 Sheetrock: [ ] Septic Sytem Final Approval: f 1 Road Approach Final Approval: [ ] Zoning Final Approval: nn f 1 Final/Occupancy Approval: v,r . I 7`ZiAb fr/ 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_Buildng.rpt 10/29/19 /s0N 0 e lS lM t5 O l� l Gk4�� ,� JEFFER1 C`NTY , 1 hr ' DEPARTMENT OF COMMUNITY DEVELOPMENT ,ate + . ' h 621 Sheridan Street • Port Townsend •Washington 98368 Iry 360/379-4450 • 360/379-4451 Fax �qs pT www.co.jefferson.wa.us/commdevelopment JEFt,aSOry COUNTY HIND r; , 0 fv r. (IpPI . - I Master Permit Application MLA: E.;0-( &c 2.L> ' Project Description) (include separate sheets as necessary): ive'cft\_.) Fyze v✓\i vv.) , 5L4�t'r(txp.,- qT iPtc/o✓>\ -A CIvC.r- C1/44ib-1 1\4) p t Tax Parcel / Property Number: f3 Z I b 3 C -, Size: l> , 71-4 A . (acres/square feet) Site Address and/or Directions to Property: I 7-4( I jf may((o y) -V-- tZ ..c V ct 4, Property Owner(s)of Record: 11i.L.51 y- `•de ✓{z, V,, L,,, . r- Telephone: ( 7 1-437 S('y Fax: '4)'13'7- 7 7 03 •email: Mailing Address: 0.1-1 I lalln-v F�,c(v_ V vcc X„ Applicant/Agent(if different from owner): `A A--k-1.e._ + L-i r1--le__ Cc- 4._s -.uG A-4,.. Telephone:MC)) 3eS' 54-0(o Fax: (3/ro7 3f�S-17 33 email: a Inc F/tr,44, -I/'[j-le-Cr., Mailing Address: Zi_,''1 I-14\ 5 f �or h ,t,',.tc ,,,Lk c -A c1s�531a£3 What kind of Permit?(Check each box that applies) Building 0 Variance(Minor,Major or Reasonable Economic Use) 0 Demolition Permit 0 Conditional Use[C(a),C(d),or C]** Single Family 0 Discretionary"D"or Unnamed Use Classification 0 Garage Attached/Detached 0 Special Use(Essential Public Facilities)** ❑ Manufactured Home 0 Boundary Line Adjustment ❑ Modular 0 Short Plat" 0 Commercial* 0 Binding Site Plan" 0 Change of Use 0 Long Plat" 0 Address 0 Road Approach 0 Planned Rural Residential Development(PRRD)/Amendments** ❑ Propane 0 Plat Vacation/Alteration** ❑Allowed"Yes" Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions" 0 Stormwater Management 0 Shoreline Management Substantial Development** 0 Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Variance ❑Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment 0 Wireless Telecommunication* 0 Jefferson County Shoreline Master Program Amendment 0 Forest Practices Act/Release of Six-Year Moratorium *May require a Pre-Application Conference **Requires a Pre-Application Conference Please identify any other local, state or federal permits required for this proposal, if known: / _ DESIGNATION OF AGENT I hereby designate -i I— ¢-- �,' (� to act as my agent in matters relating to this application for permit(s). ) OWNER SIGNATURE . /..e. / 'Yi.l.•?, Date: D7/�C77C, / By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of his,her or it's knowledge. Any material falsehood or any omission of a material fact made by the owner/agent 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 its employees,representatives or agents for the sole purpose of application review and any required later inspections.Access and right of entry to this property shall be requested and shall occur only during regular business hours. .,------ Signature: �� Date: ()f�47-2,Cf V The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the idangered Species Act'or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this .Jrmit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferable responsibility fort dheri g to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature:- -4[L, LX Ga11 Date: f j/�Z/61L1 7 G:\PCmutCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc OWNER BUILDER STATEMENT The signer of this statement does hereby crilithat Sare the Owners of the parcel referenced hill,thati are not licensed contractors and that they will be assuming the responsibility of the General Contractor for the proposed project. t a Signature: Date: \1 I ' r--- AUb - 2 2884 I. GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: L---► 44--l-C_.+ 1.,--1'f i- . C-�vtis4-vt,,c.\--‘v (MO) 3,51s-sk,pc, (36ri)3trIS- l'733 MAILING ADDRESS: 7.---LX7 c L f.i -t 1 Sf ITT" G1,1A EMAIL: c I ex p 111-1-1-C - /I i-{-(C ;.c4}a-ram CONTRACTOR'S LICENSE WAINS NUMBER: -7TTL_ L 4. r 5-7 L S NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New X Wood Existing: Li 0 Sewer 0 Addition 0 Steel Proposed: C' Bank 0 Community System XAlteration/Remodel 0 Concrete Total: 4f Height: q. Individual System 0 Repair 0 Masonry SEP Permit# ❑ Demolition 0 Other: Bedrooms: Water Supply: Existing: 3 Setback: 0 Private well 0 Two Party Type of Heat: Proposed: O 0 Public Total: 3 Name of System: If this is a Commercial Project you must answer the following: Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current Proposed IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No If this Is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: ❑ Underground Tank 0 Above ground Tank Size of Propane Tank: ❑ Heat Stove ❑ Cook Stove a Woodstove 0 Fireplace Insert 0 Hot Water Tank 0 Pellet Stove 0 Other Is this appliance being installed in a Manufactured/Mobile Home? Yes / No When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property lines, tank location and size,distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. Square Footage •For Office Use Only - Current Proposed Amount' Main Floor Consistency Review: ,, - Zlv 214u Floor Base fee: £- 3`a Floor Additional Section: Mezzanine: Plan Check fee: :, Heated Basement State Surcharge`foe: ' z35c4 s( Unheated Basement Pot Water Review fee •�� );, ;L, ,•rp� � • - Other Unheated x, tt;, , � 911/Rd Approach fees - �� ,�b 3 Garage/Carport q CO 0 Y' TOTAL: $, rti* L, Decks Receipt,Number y Other Cash/Check Number ,�'r " ESTIMATED COST(REQUIRED) A. $ , . .A+�� Date t 4 . " `,y *Fair market value of all labor and materials foundation to finish `k,; x a _: S Initials ^" g . G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc