HomeMy WebLinkAboutBLD2004-00577 • MLA04-00542
BUILDING PERMIT APPLI4ION Review Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00577 Received Date: 9/10/2004
SITE ADDRESS: U.-x.S BEACH DR
PORT LUDLOW, 98365
OWNER: WAYNE A PECK SR PHONE: (360) 437-9117
281 S BEACH DR
PORT LUDLOW WA 98365-9523
SUBDIVISION: TRAIL'S END 1ST ADD Block: Lot:
PARCEL NUMBER: 950101001 Section: 16 Township: 27 N Range: 01 E
CONTRACTOR: ACE CONSTRUCTION PHONE: (360)710-8235
PO BOX 4627
BREMERTON WA 98312-0407
Contractor's License ACECOI*044BB Expires 12/4/2001
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION NEW POLE BUILDING
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION 9,016.00 ADD'L: HEAT TYPE: UH
CODE EDITION: 2003 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: SHORELINE:
CONST TYPE: GARAGE: 560 SETBACK:
DECK: 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: 1F&W Landslide
2j f
l O(4 � � Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $181.25 KAS 09/10/04 67572
Plan Check $117.81 KAS 09/10/04 67572
State Building Code $4.50 KAS 09/10/04 67572
Total: $303.56
fib OWNER BUILDER STATEMENT _ I. y.... y ye^` , ,`.n
, N � f(ac�ts,a •that
ner of this statement does ereby .•rtify that they are the Owners of the parcel referenced . ) cc 1 !
-• trae xlorthe p ed- ecL— 1 . !
tbe. ., ... r. ' I,rr•
Date: I _, t ^rr, 1 Li
ire: _ . ;' LJU
RAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: .T. c}ft ��}�N
L7 i 3
NG ADDRESS: '3 6 ... ± • L • , if- EMAIL:
,_
WAINS
TRACTOR'S LICENSE NUMBER
BER: PHONE ( ) Fes'( )
:HRECT/ENGINEER: EMAIL
LING ADDRESS:
Shoreline- Type of Sewage Disposal:
Type:Yject
frame Type: . Bathrooms:-..P::,. , ❑ Sewer
❑ Steel
New Wood Proposed:Existing. Bank/ ❑ Community System
AdditionTotal: Height- ❑ Individual System
Repair ❑ Masonry eration/Remodel ❑ Concrete SEP Permit# X el_
Bedrooms: Water Supply:
Demolition ❑ Other: Existing: Setback: ❑ Private well ❑ Two Party
Proposed: ❑ Public
ype of Heat: Total: Name of System: A�'Are-'
If this is a Commercial Project you must answer the following: Number of ADA Parking Spaces:
Current Proposed:
Number of Parking Spaces: Proposed
Number of occupants(includes owners,tenants,employees,etc) Current Will you have Food Service? Yes / No
IBC Occupancy: IBC Type of construction:
If this is a Propane Tank and/or Appliance Installation permit,mark all of Proemsane below
that apply:
❑ Underground Tank ❑ Above ground Tank
Size ank:
❑ Heat Stove ❑ Cook Stove ❑ Woodstove ❑ Fireplace Insert ❑ Hot Water Tank ❑ Pellet Stove ❑ Other
Is this a liance bein installed in a Manufactured I Mobile Home? Yes I No
When applying for a permit to Install a propane tank you must also submit as ite lines, n sdinwinggs all
septie c buildings,
comppropes
distances from the propane tank to all property
lines,tank location and size, �, ;
Including the reserve area. . • ,,.Girt 2 r�G 'F f an?,- • . S x iz a � ,. „
S•uare Foota • x
• i its Z •q 4'e. 'A v - _: 4,,-at � , . }}'• I :., w',• T
Current Pro• : . m T _-1-•;, �:� = g �xkr
Main Floor _i .g7r C C`- - }61 ri• } ;, - t ,,: ld' 1 'lf:`--Yfi :.5�az2_ .
_,ter � . , � AiA ,F.�. ri
. A _- V' 4da 1 „ky _ i �•. �4 � � � f`i ,'
2•' Floor t u , r f 4 e s ••y 'Y•!L"v,"+'f .u�v Ec'- f'" • )•;
-i .tw!t o tl a n
L ",,, .:s, e r �•a�i� ^^6wi• •fit • '",,.Kt4 ?s-,1(A: V,Y ',�_ , sF 't ..— 11A•
3' Floor ut Y r� ;
�� � �,y ' } " � s 3 § c ;;
Mezzanine: a
Healed-Basement t a..r. z -w y. ` ::::; tC t, -u-: �, �C'a.Ety`4w �4,a.'-' ;••,. .-• s.7r AL-
r7�i(}lGl! s * k' -.,i' 'Y am �,; �"3.-t, i
s-• ,7 `aex''r'tif' t.4 AYrt� �', .4 4'- • a�,x4 ;"
Unheated Basement •-'k, ;-, ,, r~ r .. x
'S14.7.A4, . µ .A.t.,-.1 -. r".( e., -.., ,,,�+e `r[ 3yr t!,-- ''.,,Lvie(5".:. s''''
5 M1 VvC 1 Q•I'-•tt, P �Y 6 r L Z �. ${.C 'yN
Other Unheated s ,st ,� ':. A , ° �tAXt am` -
��,,,�� , x • T y+ str' � C36
Garage/Carport ,,1,..: 4i',`: •• st;,. F '- t a,, �.A *� a � �1wo-
Decks e� .> § v - 's � � � ��•
5 S '• ' .1,4•
,I t t•.'d � r,.�,?: arm R'•,
Other 4y • ) E C f u 4 s a_ 1�. ,� ,,
(.,iJIJC D COST( /`s •�� 6r'I.r I � , t 4. v, "a../> K-:& ! ...-W'.e• .,.,
ESTIMATED COST(RE•UIRED) l,,,, '-_- • -t
*Fair market value of all labor and materials foundation to finish
G:\Pe Center\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
I NI
raw Odd JEFFEF�N COUNTY — --,CI
1 ,IDEPART OF COMMUNITY DEVELOPMENT` e.. 621 Sheridan Street • Port Towgsend •Washington 98368 LI ii n .,�,!
SEr ? 0 2004 ?
., 360/379-4450 • 360/379-4451 Fax�q�, OHO$ www.co.jefferson.wa.us/commdevelopment —- -- -----
�IIN JEi FERSU', Ci��HN•I`{
DE PT. Or COMMUN (`,'D EVE.I.OPMENT
Master Permit Application MLA: 0 _ S4Z.
Project Description(include separate sheets as necessary):
PO CJ� �V►t.Ot N�- C'atic_r 1,;?../^47,-7
Tax Parcel p rty
Number: 7,Sr /0 C C c' i Pros Size: d O l'� -
(acres/square feet)
Site Address and/or Directions to Property: SD O-I i9r '4 C i I) A)/
Property Owner(s)of Record: ..,1 to V N l A. Pc CK -
Telephone:C-3[0) 4 7-91 1 7 _ Fax: email: W PECkSR e Ol YPPN.(Dltl
Mailing Address: 2 I 5nj-JTH BE.Acii DR• PORT 1,,�t r w WA 98
Applicant/Agent(if different from owner): ,4 G G e f U,5 P t' I ,n 1G) 14/T f !' !"( /J,67... f 1, C.
Telephone: 7 4!3- ("16 O Fax: 1-(r1$ ) '3- O l;,5 email:
Mailing Address: (33 G a I A 1 - SF, 2Ja/",,;0 T cc/A, % g+9. 175
What kind of Permit?(Check each box that applies)
El Building ❑Variance(Minor,Major or Reasonable Economic Use)
❑ Demolition Permit ❑ Conditional Use[C(a),C(d),or C]**
❑ Single Family ❑ Discretionary"D"or Unnamed Use Classification
❑Garage Attached/Detached ❑Special Use(Essential Public Facilities)**
❑Manufactured Home ❑ Boundary Line Adjustment
❑ Modular ❑Short Plat**
❑Commercial* ❑ Binding Site Plan**
❑Change of Use ❑ Long Plat**
❑ Aro f ess ss ❑ Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments*"
❑ Plat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis ❑Shoreline Master Program Exemption/Permit Revisions**
❑ Stormwater Management ❑Shoreline Management Substantial Development**
❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Variance
❑Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium
*May require a Pre—Application Conference **Requires a Pre-Application Please identify any other local,state or federal permits required for s proposal, if known Conference
DESIGNATION OF AGENT
I hereby designate I act as my agent in matters relating to this application for permit(s).
OWNERSIGNATUREc.....e.
Date: 9/ 7/011
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. ;7;11
Signature / f%? �' \3 C'
(( Date: t"// 7-/ tl
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 lake"of an endangered species as those terms are defined in the federal law known as the
"Endangered Species Act"or"ESA?Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this
permit 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 respor st�ty for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: �j y
,l Date: 7---7-z':':7
G:\PennitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
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