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Home My WebLink AboutBLD2004-00625 11) BUILDING PERMIT • Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD04-00625 Received Date 10/4/2004 SITE ADDRESS: 56 EXPLORER LN Issue Date 10/25/2004 PORT LUDLOW, 98365 APPLICANT: PURLY S DENNON PHONE: (360)437-2984 MARGARET A DENNON 56 EXPLORER LN PORT LUDLOW WA 98365-9616 SUBDIVISION: PORT LUDLOW NO. 2 Block: Lot: 167 PARCEL NUMBER: 990603167 Section: 9 Township: 28 N Range: 01 E CONTRACTOR: OWNER/BUILDER PHONE: PROJECT DESCRIPTION: REPAIR EXISTING DECK - NO CHANGE IN FOOTPRINT - NO MLA REQ'D CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. SETBACKS: UFFER: Footing: ev /4044./iv Foundation: 9A' ia116/G/" Stormwater FINAL Approval: Underground Plumbing: Underground Insulation: Shear Wall : Framing: j},e .3� ` �' Plumbing: Propane Tank/ Lines: Insulation: Sheetrock: Septic Sytem Final Approval (If not on sewer): Road Approach Final Approval: Zoning Final Approval: Final/Occupancy Approval: K P;yki 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 BLD04-00625 UILDING PERMIT APPLICAION Review Type:l Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD04-00625 Received Date: 10/4/2004 SITE ADDRESS: 56 EXPLORER LN PORT LUDLOW, 98365 OWNER: PURLY S DENNON PHONE: (360)437-2984 MARGARET A DENNON 56 EXPLORER LN PORT LUDLOW WA 98365-9616 SUBDIVISION: PORT LUDLOW NO. 2 AREA 3 Block: Lot: 167 PARCEL NUMBER: 990603167 Section: 9 Township: 28 N Range: 01 E CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP REPAIR EXISTING DECK - NO CHANGE IN FOOTPRINT - NO MLA REQ'D TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP REP MAIN: VALUATION 1,500.00 ADD'L: HEAT TYPE: CODE EDITION: 2003 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: # OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: 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 �J F&W Landslide o I (oc( 3 Shoreline Aquifer Forest: Commercialt ra Type Amount Paid Bv: Date: Receipt: �Apprrove / e Permit $57.05 KAS 10/04/04 67776 OCT 2 5 2004 Plan Check $37.08 KAS 10/04/04 67776 Jefferson County Planning State Building Code $4.50 KAS 10/04/04 67776 & Building Department Total: $98.63 CO , OLLike— " TC IllOWNER BUILDER STATEMENT • The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be 4 assumi theses on ibility of e General Contractor for the proposed project. j r / Signature: 11, Date: /( ,! i .' --/ GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER 1 ARCHITECT/ENGINEER: PHONE ( ) i Pi ! FAX: ( ) i. MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New 0--Wood Existing: .2 y4l I Sewer ❑ Addition ❑ Steel Proposed: Bank LI Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System P.-Repair ❑ Masonry SEP Permit# O Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: Li Public Total: 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: O Underground Tank ❑ Above ground Tank Size of Propane Tank: ❑ Heat Stove ❑ Cook Stove ❑ Woodstove 0 Fireplace Insert ❑ Hot Water Tank ❑ Pellet Stove ❑ 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: /--* 2""Floor Base fee: 3`a Floor Additional Section: Mezzanine: Plan Check fee: 41 Heated Basement State Surcharge fee: ' Unheated Basement Pot Water Review fee: "[ /.... Other Unheated 911/Rd Approach fee: ./.'e Garage/Carport TOTAL: $ q r. c,s Decks Receipt Number: ( 711 C. Other Cash/Check Number: 11 a 1 ESTIMAT COS EQUIRED) Date:•F ' a ue of all labo and materials foundation to finish 10 l/4--1 6�1 n 5"cr Initials: i G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc , ¢SON CO0 JEFFERSOf�UNTY ` �` I`._ t' 1 w i DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend •Washington 98368 ►1 ,, 360/379-4450 . 360/379-4451 Fax (00 www.co.jefferson.wa.us/commdevelopment $INO -0 1K ar Master Permit Application MLF1-464 QQ Project Description(include separate sheets as necessary): £L1 O/LO 77/ PA U.`,'cX f,4Me" 007- ,e,,ur 4S c' Tax Parcel Property Number: 94-2`' •O3 / 6 7 Size: (acres/square feet) Site Address and/or Directions to Property: J�lc E 7(PLLl'/Z ,02T L-1>,[Jt _ )c.e / (..t)f Property Owner(s)of Record: L'MAIL J7E/UdC)O/L-) Telephone: Z-C 9e y Fax: email: Mailing Address: ;;� n►C Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies) ❑ 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** ❑Address ri Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** ❑ Propane ❑ 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* 11 Jefferson County Shoreline Master Program Amendment ❑ 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 to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: 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 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 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 ' ht of entry to this property shall be requested and shall occur only during regular business hours. Signature: Yt —v—� i�iYr�J—v� / Date: / 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 "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. My 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 Je on County development code.The Applicant acknowledges that he,she or it holds individual and non-transferable r onsibility for adhering nd complying with the ESA. The Applicant has read this disclaimer nd sii s and dates it below. 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