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Home My WebLink AboutBLD2005-00319 • 4143UILDING PERMIT APPLIC•ON BLRDOe 00319 Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD05-00319 Received Date: 5/16/2005 SITE ADDRESS: 192 NELSON'S LANDING RD PORT TOWNSEND, 98368 OWNER: RICHARD T GIBSON PHONE: 360-379-0710 192 NELSONS LANDING RD PORT TOWNSEND WA 98368-9648 SUBDIVISION: Block: Lot: T11 PARCEL NUMBER: 001174002 Section: 17 Township: 30 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI EXISTING DECK REPAIR - NO MLA RQRD TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF.IMP REP MAIN: VALUATION 3,000.00 ADD'L: HEAT TYPE: CODE EDITION: 2003 - HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: - Prop: Total: Total: Routing Date: /�(1-e)/0S— Type Amount Paid By: Date: Receipt: A proved/Date Permit $83.25 BAC 05/16/05 73129 APPRt )VE") Plan Check $54.11 BAC 05/16/05 73129 State Building Code $4.50 BAC 05/16/05 73129 JUN 1 6 2005 . Total: $141.86 Jefferson County Planning & epartment R2 • BUILDING PERMIT• Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD05-00319 Received Date 05/16/2005 SITE ADDRESS: 192 NELSON'S LANDING RD Issue Date 06/16/2005 PORT TOWNSEND, 98368 APPLICANT: RICHARD T GIBSON PHONE: 360-379-0710 192 NELSONS LANDING RD PORT TOWNSEND WA 98368-9648 SUBDIVISION: Block: Lot: T11 PARCEL NUMBER: 001174002 Section: 17 Township: 30 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: PROJECT DESCRIPTION: EXISTING DECK REPAIR - NO MLA RQRD CALL IN FOR THEQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. SETBACKS: 8-�-(0� UFFER: Footing S 5-ms Foundation: Stormwater FINAL Approval: Underground Plumbing: Underground Insulation: Shear Wall : Sheathing: Framing: 4/'11`tig Plumbing: Propane Tank/ Lines: Insulation: Sheetrock: Septic Sytem Final Approval (If not on sewer): Road Approach Final Approval: Zoning Final Approval: Final/Occupancy Approvals-_(.0 LY7 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 • OWNER BUILDER STATEMENT • The signer of this s nt s h y certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assu ' si the General Contractor for the proposed prof, Signature: c Z~ Date: _ / / 3/e GENERAL CONTRACTOR OR MANUFACT REp,HQME INSTt: PHONE: FAX: MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE MAY 1 6 2005 , . ` WAINS NUMBER: _—J NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: I l New f Wood Existing: ❑ Sewer I I Addition ❑ Steel Proposed: Bank ❑ Community System C I Alteration/Remodel ❑ Concrete Total: Height: I I Individual System Repair ❑ Masonry SEP Permit# I l Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: Li Private well ❑ Two Party Type of Heat: Proposed: I l 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: I1 Underground Tank CI Above ground Tank Size of Propane Tank: I I Heat Stove Ll Cook Stove I I Woodstove I i Fireplace Insert I 1 Hot Water Tank I I Pellet Stove I I 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: 2Nu Floor Base fee: 6� ,2� 3rd Floor Additional Section: --------- Mezzanine: Plan Check fee: 54 (I Heated Basement State Surcharge fee: 14.• .501 Unheated Basement Pot Water Review fee: -------- Other Unheated 911/Rd Approach fee: Garage/Carport - TOTAL: $ �4 ( , y Decks Receipt Number: (3 f Other Cash/Check Number: ^ 32� ESTIMATED COST(REQUIRED) Date: /��/O� •Fair market value of all labor and materials foundation to finish .. .jC'�C.,0, 0 aV-CZ. Initials: G:\PennitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc ¢gON cp�� JEFFERSON JNTY • DEPARTMENT OF COMMUNITY DEVELOPMENT A D^ `'� 621 Sheridan Street • Port Townsend •Washington 98368 - PC-) j(A 360/379-4450 • 360/379-4451 Fax p� www.co.jefferson.wa.us/commdevelopment -- 1SHING Master Permit Application MOO Project Description(include separate sheets as necessary): i? i g1Si/IL)G- 2> c: Tax Parcel Property Number: 0 0 1 1 7 q C'C`) �_ Size: [ : ' AeR‘=5 (acres/square feet) Site Address and/or Directions to Property: I c( 2 N C1-50 e., J 6- c .6 1-Do R T->:c'n;s c—nrdl EAL4_ y,&?� Property Owner(s)of Record: ►. G,,Ci s o r-1 Telephone: 3 0 3 1 - v 7 i o Fax: email: Mailing Address: i cf L.4AINN 2t� Po2r- b 1. 95; k's- Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies) Ll Building ❑Variance(Minor, Major or Reasonable Economic Use) 0 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 0 Modular ❑ Short Plat** ❑Commercial* ❑ Binding Site Plan** ❑ Change of Use Cl Long Plat** ❑Address l I Road Approach O Planned Rural Residential Development(PRRD)/Amendments** 0 Propane 0 Plat Vacation/Alteration** 0 Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions** ❑ Stormwater Management Ll Shoreline Management Substantial Development** ❑ Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Variance 0 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 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 require a ins is.A ss and right of entry to this property shall be requested and shall occ only du ing regular business hours. ( Signature: Date: / j o 5- 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."Jefferso ply makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued will not v' to th SA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if you are in p• ' th efferson County development code.The Applicant acknowledges that he,sh or it holds individual and non-transfers )is`pyafi ' II' f n to an complying with the ESA. The Applicant has read this disdai (er and igns and dates it below. Signature: c- L Date: / 6 G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc n;v� xtio -7/1m ` (1 Z--'\-,'D -Ay m O D x O � D 73 n m qt S Q 4 )1 G N -131-4' r:;-1 i i NJ -I 72 _ _ 4l c , rn t c ci cy, 17 .- GI 1 r r, m . / ( ' RI v - m r—( 1 _ Z_ co o 4 -- d I Z i� Cl z' to Ai c n ..m ,) UN Z t a `1 c• o, ,, co u,‘ -=T T" 7:0- _ i o -) cs Z 1)m L z c A ._ 3 N 7J \ o 7 m m 'V ✓ R aCl) o N z p Cm n Z E. n Z. (Z r --- ----1 _ g" v 1 1 d * -Co) 0 . ,1 C. G i I — 1,- . , ,,„, 1 vo _.__ __.-- o d 0