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Home My WebLink AboutBLD2004-00787 alk UILDING PERMIT APPLICAN BRDOW00pe787 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD04-00787 Received Date: 12/8/2004 SITE ADDRESS: 61 CANAL LN BRINNON, 98320 OWNER: SILAS L SMITH PHONE: (360) 796-3489 812 SI TOWN RD CASTLE ROCK WA 98611-9378 SUBDIVISION: OLYMPIC CANAL ADDITION 1 Block: Lot: PARCEL NUMBER: 980100319 Section: 21 Township: 25 N Range: 02 W CONTRACTOR: SEATIME SERVICES INC PHONE: (360) 765-3749 7425 THORNDYKE RD REPRESENTATIVE: GREG BARRON PHONE: (360) 765-3749 PROJECT DESCRIPTION ADDITION ON EXISTING FOUNDATION NO INCREASE IN FOOTPRINT - NO MLA REQRD TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP ADD MAIN: 60 VALUATION 10,000.00 ADD'L: HEAT TYPE: EEE CODE EDITION: 2003 HEAT BASE: HEAT TYPE: OCCUPANCY: R-3 UNHEATED: # OF STORIES: OCCUPANCY: OTHER: CONST TYPE: 5N GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: 40 BANK HEIGHT: 10 SEWAGE DISPOSAL: CON WATER SYSTEM: PUD PARCEL TAGS: YES NO BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA Exist: 1 Exist: 2 Wetland Erosion Prop: Prop: Seismic Streams Total: 1 Total: 2 Flood Way Floodplain Routing Date: F&W Landslide (�7 I(2 Shoreline Aquifer Forest: Commercial Rural Type Amount Paid By: Date: Receipt: Approved/Date Permit $181.25 BAC 12/09/04 68820 APPROVED Plan Check $117.81 BAC 12/09/04 68820 State Building Code $4.50 BAC 12/09/04 68820 JAN 1 1 2005 Total: $303.56 Jefferson County Planning & Building De artment 41-. 0-14.6,Ppg. ---I • • BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD04-00787 Received Date 12/8/2004 SITE ADDRESS: 61 CANAL LN Issue Date 01/11/2005 BRINNON, 98320 APPLICANT: SILAS L SMITH PHONE: (360) 796-3489 812 SI TOWN RD CASTLE ROCK WA 98611-9378 SUBDIVISION: OLYMPIC CANAL ADDITION 1 Block: Lot: PARCEL NUMBER: 980100319 Section: 21 Township: 25 N Range: 02 W CONTRACTOR: SEAHOME SERVICES INC PHONE: (360) 765-3749 7425 THORNDYKE RD PORT LUDLOW WA 98365 PROJECT DESCRIPTION: ADDITION ON EXISTING FOUNDATION NO INCREASE IN FOOTPRINT - NO MLA REQRD CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. SETBACKS: UFFER: Footing: Foundation: Stormwater FINAL Approval: Underground Plumbing: Underground Insulation: Shear Wall : Framing: dkW/,1 o4eiol A Plumbing: �, /Vie,; Propane Tank/ Lines: Insulation: %`If__ d—, Sheetrock �-5—Septic SytFin A royal (If not on sewer): Road Approach Final Approval: Zoning Final Approval: Final/Occupancy Approval: . 3/ � - 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 • PQ)rR SON coG� JEFFERSON COUNTY /. ,a DEPARTMENT OF COMMUNITY DEVELOPMENT '' 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax �` ,.... ,,A9 www.co.jefferson.wa.us/commdevelopment c.. ; i -iu'��. .., Master Permit Application MLA: Project Description(include separate sheets as necessary): Tax Parcel CI SO l O O`� I .l Property ��O S g f-(((acres/square ) Number: J// Size: acres/ uare feet Site Address and/or Directions to Property: t I C-Pt N PI-L (_tot tJ Property Owner(s)of Record: 6;'LtC> g, IYt-it Telephone: 36o 7"I b - 3'-1e l Fax: email: Mailing Address: el),a sr 1-0v.7 try R.A. c-(2.1L'L 12_64.4 (-u-tc 9 k C Applicant/Agent(if different from owner): vim'{ Q Ptr -otJ Telephone: 360 -7 CS- 37`I9 Fax: 36 0 76S— 96'S/ email: MAIL e.k 1^1owte.c4,-,. Mailing Address: '7`72S 77 rs) dy k What kind of Permit?(Check each box that applies) XrBuilding U Variance(Minor,Major or Reasonable Economic Use) U Demolition Permit U Conditional Use jC(a),C(d),or C]** U Single Family U Discretionary"D"or Unnamed Use Classification U Garage Attached/Detached U Special Use(Essential Public Facilities)** U Manufactured Home U Boundary Line Adjustment U Modular U Short Plat** U Commercial* U Binding Site Plan** U Change of Use U Long Plat** U Address I Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** U Propane U Plat Vacation/Alteration** U Allowed"Yes"Use Consistency Analysis U Shoreline Master Program Exemption/Permit Revisions** U Stormwater Management U Shoreline Management Substantial Development** U Site Plan Approval Advance Determination(SPAAD)* U Shoreline Management Variance U Temporary Use U Comprehensive Plan/UDC/Land Use District Map Amendment U Wireless Telecommunication* U Jefferson County Shoreline Master Program Amendment U Forest Practices Act/Release of Six-Year Moratorium *May require a Pm—Application Conference **Requires a Pre-Application Conference Please identify any other local,state or federal permits required for this proposal, if known: DESIGMATIOWOF AGE I hereby designate (71e1 (;fie-o/J to act as my agent in matters relating to this application for permit(s). It 4 At.- A" r -...-cti .4Q7 /g� u27,1 Date: if -R, 6 cA if 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 right of entry to this property shall be requested and shall occur only during regular business i%c, hours. ,� G Signature:.44 Y�yy Date: 1/ 26 d it 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. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your 4 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 reess onsibility for a ering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: ` /( � �� Date: 11 26 d 14- C:\Documents and Settings\mochil\Desktop\Master Permit Application 7-8-04.doc t . . • • OWNER 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 assuming the responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: $vfItA6VIA,.- Sc,r u tics =-I-A c_ (3(4 ) 76S 3-7 / (36° ) 76S—`7Ss 1 MAILING ADDRESS: 7l1IS ^�.�r I � 0— ( EMAIL: CONTRACTOR'S LICENSE C� "41 "I ��c' WAINS NUMBER: 7J (kS 1 0 r‘,..S NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Fr�a a Type: Bathrooms: Shoreline: Type of Sewage Disposal: J New Ik'Wood Existing: LJ Sewer Addition u Steel Proposed: o Bank u Community System J Alteration/Remodel u Concrete Total: :Z Heigl}t: ,lendividual System Repair u Masonry /D SEP Permit# ,&pf&S—CTOO11 _I Demolition a Other: Bedrooms: Water Supply: Existing: I Setback: a Private well a Two Party Type of Heat: Proposed: 0 r Public 4-tee*CL Total: / YO 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: i Underground Tank i Above ground Tank Size of Propane Tank: I Heat Stove I Cook Stove I Woodstove i Fireplace Insert i Hot Water Tank 1 Pellet Stove t 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 60 Consistency Review: 2"u Floor Base fee: 1S zS 3`O Floor Additional Section: f Mezzanine: Plan Check fee: ii7 , l Heated Basement State Surcharge fee: 4-s0 Unheated Basement Pot Water Review fee: L/ Other Unheated 911/Rd Approach fee: Garage/Carport TOTAL: $ Jt," ✓. � Decks Receipt Number: /,`7CT0 Other Cash/Check Number: l ig mai- ESTIMATED COST(REQUIRED) Date: r/ r -s .Fair et value of all labor and mateals foundation to finish C r a 0 0 �/ Initials: (� . ... ,np:4,,,,„„...-- C:\Documents and Settings\mochil\Desktop\Master Permit Application 7-8-04.doc e` j . *41; tN,Itiri'DC13