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HomeMy WebLinkAboutBLD2005-00232 etJILDINGTT�N PERMIT APPLICA MLA05-00231 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD05-00232 Received Date: 4/18/2005 SITE ADDRESS: 40 SPRUCE DR PORT TOWNSEND, 98368 OWNER: MICHAEL HINOJOS PHONE: (360) 385-7044 40 SPRUCE DR PORT TOWNSEND WA 98368-8908 SUBDIVISION: CAPE GEORGE VILLAGE DIV 3 Block: Lot: 33 PARCEL NUMBER: 940500032 Section: 13 Township: 30 N Range: 02 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI ADDITION OF 2ND STORY TO EXISTING TO GARAGE & DECK ALSO 120 GALLON A/G PROPANE TANK TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP ADD MAIN: VALUATION 45,000.00 ADD'L: 360 HEAT TYPE: PRO CODE EDITION: 2003 HEAT BASE: HEAT TYPE: OCCUPANCY: OCCUPANCY: UNHEATED: #OF STORIES: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: 90 BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: CAPE GEO BEDROOMS: BATHROOMS: Exist: 1 . Exist: 1 Prop: 1 Prop: 1 Total: 2 Total: 2 Routing Date: �I I qlp Type Amount Paid By: Date: Receipt: Approved/Date Permit $593.25 BAC 04/18/05 71879 Plan Check $385.62 BAC 04/18/05 71879 State Building Code $4.50 BAC 04/18/05 71879 Potable Water Application $53.00 BAC 04/18/05 71879 Total: $1,036.37 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 mi the res Vilify of t�e neral Contractor for the proposed project. Signature: //,� _ .s€ Date: O /16 DS- GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ( ) ( ) MAILING ADDRESS: — EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New f Wood Existing: i 0 Sewer Addition , . 0 Community System i p' ❑ Steel Proposed: _� Banka , ❑ Alteration/Remodel ❑ Concrete Total: _;1_. Height: Individual System ''z t,,' ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: 0 Private well ❑ Two Party Type of Heat: Proposed: �_ .,RC i'4A) Total: -__..4____ Public f 4. Name of System: (.4 / 6 t 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 appl l ❑ Underground Tank la Above ground Tank Size of Propane Tank: 2,`: . /i�e, -L ,el Heat Stove ❑ Cook Stove ❑ Woodstove ❑ Fireplace Insert ❑ Hot Wer Tank ❑ Pellet Stove 0 Other Is this appliance being installed In a Manufactured/Mobile Home? Yes /7No 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 properly lines,buildings and septic system components, t t including the reserve area. -— — Square Footage ' orOffice lu>�y _ ; , Current Proposed ^mount , . !f, Main Floor . 'Consistency'R vlew: _ i ptr ;..�� 2""Floor l nn cc,�� �^ se fee` � R 1 6 I,: : 4 } '`' s 4 rl 3"'Floor Ofi {.(J ition�l Seri f` i` �_ • Mezzanine: - Elan tckfle ,'I &V "I �` £Heated Basement :1 - f Unheated Basement Pot Water � f s , : Other Unheated • i Y r °' '� t�° �� 8 e 911/Rd h fee .:j G r3 i ` v w t > Garage/Carport Y ,u 3 , TQTAL ' $ t„ 1 i 5_ ,7 Decks r , , �� .� n / of 0 a �.w 2ecOipt Number t45 y Other hrCh Nut t" s .� �� y 7., 3 ,, } )i S i dA 4 ' . ty k' M .ti t JJ4 ; e _ 4�1 t EFv; 'U j ESTIMATED COST(REQUIRED) Gpaa.to Dato .,: ';.j�, t �' -:‘.iiii:).-t..--;,:„ , *Fair m .,_ a ma s foundation to finish : - �, ,� G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc fa, 4i?-• , cue, JEFFERSON CioniO i ' DEPARTMENT OF COMMUNITY pEVELOPMENT i 621 Sheridan Street• Port Tow'nseind •Washington 98368 360/379-4450 • 360/379-445 Fax 1 ��5. o www.co.jefferson.wa.us/comrndeve oprAPI 6 Master Permit Application MLA: 03 `a 1 Project Descriptionn(include separate sheets`as necessary`-- --`- ,/;i l i c!`J f.,�' 7 SA 11/ 6' Z. .Al ,(iAJD d? fi( L'''0/v, ' f 4c, Tax Parcel < Property .� Number: () Size: a 6 t r (acres/square feet) Site Address and/or Directions to Property `�-`E) .,) ,e0,4 GC C'.4f L){t., //�'Crf j /(),_,0 h,_i ,ifs,j,j V/ 4 6-s-��, Property Owner(s)of Record: /`/1� / C- /VA.,'F / I-!/� �, -W-: Telephone: .7 c:� tr' 7 Fax: email: Mailing Address: L..X .,'^ Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies) Building f` 001 r f,'c :J ❑ 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 0 Long Plat** ❑Address ❑ Road Approach ❑ Planned Rural Residential Development(PRRDyAmendments** Cl 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* ❑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: , ISIGNATION 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 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: `'.�,-ee"' 4 .+-e.,1 2. - < Date: 0?'/g�../ 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-trans g,r)le respo'ibility for,.adhering to and complying with the ESA. The Applicant has read this disclaimer and signsig and dates it below. Signature: �� '.-'�{/..17-j' 'f n"-- 1'f-<'P Date: �c/ 0,S :\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc L--; c <<,, _ /X \35.11� o gym - k, - `f+ -, s z Z't �r Z 1:1 r a m �, 7C'" a • / / -- (i) C7 ---c) /-ti c m ,: 07 RI c *y 1, rn m ��` j0 t11� — —1 11, •-L.,. .—‘5;'," ,/ / , ., t. , • S l .____._._._ . ? C'' 130' rn'P!%� V Cp -_1 a-, U, -A W N — Ul 0 CM (./.-) (,n Trl r o til o o — - t , i (�__7) o C. Vn -n 7 3 t-ri n �-1- ��..7 • —I ?G v _ = H rat - 4 1_._.. 0-, c` D _N. r - --- 4w. En a Z. c z CD Z V c...�-, M -�'� p O W 0, (..ti.) rri © (r) (---, \ r 0 Xf -13 • OD g a. MI )♦ --40 SPRUCE DR • BLD05-232 _ H NOJOS _____ 1 1 Approvals Req't`%o to Final Inspect} P 111/41‘1 I P. ..‘.. .. ram