HomeMy WebLinkAboutBLD2005-00055 410 •
BUILDING PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD05-00055 Received Date 01/27/2005
SITE ADDRESS: 51 FIR PL Issue Date 02/7/2005
PORT TOWNSEND, 98368
APPLICANT: DAVID W SULLIVAN PHONE: 360-379-2755
CONNIE S ROSS
51 FIR PL
PORT TOWNSEND WA 98368
SUBDIVISION: CAPE GEORGE VILLAGE DIV 3 Block: Lot: 68
PARCEL NUMBER: 940500067 Section: 13 Township: 30 N Range: 02 W
CONTRACTOR: RAVENSWOOD CARPENTRY PHONE: (360)683-3441
10 SALAL WAY
SEQUIM WA 98382
Contractor's License: RAV:.NC*077OZ Expires: 2/14/2007
PROJECT DESCRIPTION: NO MLA REQUIRED - REMODEL BATHROOM -STAYING
W/EXISTING FOOTPRINT
CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT.
SETBACKS:
UFFER:
Footing:
Foundation:
Stormwater FINAL Approval:
Underground Plumbing:
Underground Insulation:
Shear Wall : 4.
'
Framing: 7 )-
Plumbing:,y 11.
Propane Tank/ Lines:
Insulation:
Sheetrock:
Septic Sytem Final Approval (If not on sewer):_
Road Approach Final Approval:
Zoning Final Approval: 1 /
Final/Occupancy Approval: ` ' c//i.1/C;"�
i
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
•UILDING PERMIT APPLICATION NO MLA RQRD
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD05-00055 Received Date: 1/27/2005
SITE ADDRESS: 51 FIR PL
PORT TOWNSEND, 98368
OWNER: DAVID W SULLIVAN PHONE:
CONNIE S ROSS
51 FIR PL
PORT TOWNSEND WA 98368
SUBDIVISION: 7%1E VILLAGE DIV 3 Block: Lot: 68
PARCEL NUMBER: 940500067 Section: 13 Township: 30 N Range: 02 W
CONTRACTOR: RAVENSWOOD CARPENTRY PHONE: (360)683-3441
10 SALAL WAY
SEQUIM WA 98382
Contractor's License RAVENC*0770Z expires 2/14/2007
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION NO MLA REQUIRED - REMODEL BATHROOM - STAYING W/EXISTING
FOOTPRINT
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP ALT MAIN:
VALUATION 3,000.00 ADD'L: HEAT TYPE: EEE
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: CON
WATER SYSTEM: PUD 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&W Landslide
f 3// Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $83.25 INT 01/27/05 71309 /tl p P R c ' /E D
Plan Check $54.11 INT 01/27/05 71309 /� �/
State Building Code $4.50 INT 01/27/05 71309
FEB - 7 2005
Total: $141.86
Jefferson County Planning
p, dinrn
ent
�g$pN cod, JEFFERSON COUNTY
i ' �, DEPARTMENT OF COMMUNITY DEVELOPMENT
` 621 Sheridan Street • Port Townsend •Washington 98368 JAN 2 ) 2005
360/379-4450 • 360/379-4451 Fax
�q p� www.co.jefferson.wa.us/commdevelopment
S`�NGrS
Master Permit Application MLA: f\]Q ►r�(.ATQC6•
Project Description(include separate sheets as necessary):) ;,Q� �� � f
-iteAt
Tax Parcel „ V r Property
Number: "14 U - `j 00 • tv(S,7 Size: I I (c C N C( S (acres/square feet)
Site Address and/or Directions to Property: ( 1 ,/ Q[(' " r I 1
; I St LU(� Cj b ,f
Property Owner(s)of Record: C�0 I )n,L `-- _ s c>c-,` e bCtk,,,d LAD Si I,v Ct rm
Telephone:.- It:El, ,3-)-I -- ")'-)tj Fax: ` email: h-xnr,tvO }++Cro;bK Q(L ,C:1;,1
Mailing Address: -)Cir Q.- `
Applicant/Agent(if different from owner): , c-) G 41
Telephone: .0 Q F� 39 Lit Fax: S.a,-t ,_ " mail: V e y;t?, '( ,•,p
Mailing Address: /(` icc I(_. ) t..1r•.t,S_1t L,k C,i'I3&7- C)1 j0.4).b..;5_vl
What kind of Permit?(Check each box that applies)
g Building ❑ Variance(Minor, Major or Reasonable Economic Use)
❑ Demolition Permit ❑ Conditional Use[C(a),C(d),or C]**
(X Single Family ❑ Discretionary"D"or Unnamed Use Classification
0 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 i l Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments**
❑ Propane El 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 Conference
Please identify any other local, state or federal permits required for this proposal, if known:
DESIGNATION OF AGENT
I hereby designate c.L L-,t,t< • i;e rr r-/C(e t/ r_ttb�att my agent in matters relating to this application for permit(s).
OWNER SIGNATURE(
\ " ( ->> —�' Date: I— ((,
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
hours. /
Signature:_c/L �.� n �.`�A ,_ Date: 1/Z// 1--i5
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
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-transf ble responsibility for ad erin to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature. Date: I /Z.7 /t€
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
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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: PHON C�., j-3 yy VAX:
& w_ ( .ems-- CI,- im. "" t _ ii r e---ti . , ),.3e i _.3c37 7 ( )
snVi.f
MAILING ADDRESS:
/),r,� 5c( 1 G,l I 5, SL,it Vtot EMAIL: VILEAzAAS 1c-)p O) \.Y1 r,;.'E'
CONTRACTOR'S LICENSE ✓ WAINS
NUMBER: RA V V /)C 07•7OM- NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX: ( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New •g Wood Existing: ❑ Sewer
❑ Addition ❑ Steel Proposed: Bank ❑ Community System
l . Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System
LI Repair ❑ Masonry SEP Permit#
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Party
Type of Heat: Proposed: ❑ Public '\
EiCt*s Total: Name of System:
Ce i I : c� Pct. -e i1
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 1 1 Above ground Tank Size of Propane Tank:
❑ Heat Stove I I Cook Stove I Woodstove I Fireplace Insert ❑ Hot Water Tank l 1 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:
2ND Floor Base fee: B 3 a b
3fa Floor Additional Section:
Mezzanine: Plan Check fee: y
Heated Basement State Surcharge fee: -v �
Unheated Basement Pot Water Review fee: /3_.,,,
Other Unheated 911/Rd Approach fee: "C
Garage/Carport TOTAL: $ i I.4(a°(°
Decks Receipt Number: 113 019
Other Cash/Check Number: ga,5 3
ESTIMATED COS UIRED) Date: l i a-/os
•Fair market val of all labor and materials foundation to finish ` t
`3`1c,2ci� Initials: C
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