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Home My WebLink AboutBLD2005-00367 111 BUILDING PERMIT APPLI!I'ION BL Review T Ty y 367 pe:I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT it: BLD05-00367 Received Date: 6/3/2005 SITE ADDRESS: 210 SUNSET BLVD PORT TOWNSEND, 98368 OWNER: PATRICIA D HARTMAN • PHONE: 360-385-0405 PO BOX 761 PORT TOWNSEND WA 983680761 CAPE GEORGE COLONY DIV 2 SUBDIVISION: Block: 3 Lot: 7 PARCEL NUMBER: 938100307 Section: 12 Township: 30 N Range: 02 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT,DESCRIPTIOr REMODEL/CONVERTING 1ST FLOOR OF ADU/ NOT OUTSIDE EXISTING FOOTPRINT & CHANGING OUT WINDOWS NO MLA RQRD TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP ALT VALUATION 52,000.00 MAIN: CODE EDITION: 2003 ADD'L: HEAT TYPE: OIL OCCUPANCY: HEAT BASE: 192 HEAT TYPE: EEE OCCUPANCY: UNHEATED: #OF STORIES: CONST TYPE: OTHER: GARAGE: SHORELINE: CONST TYPE: SETBACK: 120 DECK: BANK HEIGHT: SEWAGE DISPOSAL: SEW WATER SYSTEM: CAPE GEO BEDROOMS: BATHROOMS: Exist: } Exist: Prop: Prop: Total: 3" Total: Routing Date: /_/ /D 5 Type . Amount Paid Bv: Date: Receipt: Approved/Date Permit $657.75 BAC 06/03/05 73238 APPROVED Plan Check• $427.54 BAC 06/03/05 73238 State Building Code $4.50 BAC 06/03/05 73238 JUL 2 9 2005 Potable Water Application $53.00 BAC 06/03/05 73238 Total: efferson County Planning $1,142.79 uil epartment fa® A 4110 BUILDING PERMIT II Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD05-00367 Received Date 06/3/2005 SITE ADDRESS: 210 SUNSET BLVD Issue Date 07/29/2005 PORT TOWNSEND, 98368 APPLICANT: PATRICIA D HARTMAN PHONE: 360-385-0405 PO BOX 761 PORT TOWNSEND WA 983680761 SUBDIVISION: CAPE GEORGE COLONY DIV 2 Block: 3 Lot: 7 PARCEL NUMBER: 938100307 Section: 12 Township: 30 N Range: 02 W CONTRACTOR: OWNER/BUILDER PHONE: PROJECT DESCRIPTION: REMODEL/CONVERTING 1ST FLOOR to ADU/ NOT OUTSIDE EXISTING FOOTPRINT & CHANGING OUT WINDOWS NO MLA RQRD CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. SETBACKS: UFFER: Footing: Foundation: Stormwater FINAL Approval: Underground Plumbing: Underground Insulation: Shear Wall : Sheathing: Framing: ?-(7-0Y Plumbing: 3-Czs Propane nk/ Lines: Insulation: 8'I1-oS- Sheetrock: Septic Sytem Final Approval (If not on sewer): Road Approach Final Approval: Zoning Final Approval: Final/Occupancy Approval -13' 7-' HEALTH DEPARTME 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 SPECIAL CONDITIONS APPLY - SEE REVERSE V SPECIAL CONDITIONS FOR CAt BLD05-00367 • 1.) Number of bedrooms limited to a total of two in structure. To be verified and documentation completed by Building Inspector prior to final. I:\F_BLD_Permit_Buildng.rpt 10/29/19 eg•gON co� JEFFERSOSOUNTY • fF7TAi 'iq DEPARTMENT OF COMMUNITY DEVELOPMENT v >` `� 621 Sheridan Street • Port Townsend •Washington TV 360/379-4450 • 360/379-4451 Fax �qs, p� www.co.jefferson.wa.us/commdevelopment Master Permit Application .�. J NO L A- cp1; Project Description (include separate sheets as necessary): (Z`tiu-Cli L 4 CA 414-t.tr-2 C)tti 0t- bdiDJ 0tJA)StcT o c l OFFee)-/-/04,4' Tax Parcel r Propdrty Number: 7.3 {'� -/d 0 - 3(1 � nnSize: (acres/square feet) Site Address and/or Directions to P operty: 2 ( o St(A S (' !,g L. /�(/' 1) re)/uT d�✓�S nrD 6-4 Property Owner(s)of Record: t eta v( % k c- 0 chop.tvvlCt+-� Telephone: 3(o c' - '75{S- CY d S Fax: email: Mailing Address: Pr. 4 6,K '7 4% l Poc-r. 7'd col S ,,. 0 c--4- ?f 3(o r Applicant/Agent(if different from owner): c/4--vt Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies) >1 Building ❑ Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit ❑ Conditional Use[C(a), C(d),or C]** Zingle Family /2...12,1A-ccee,e ❑ Discretionary"D"or Unnamed Use Classification ❑ Garage Attached/Detached 0 Special Use(Essential Public Facilities)** ❑ Manufactured Home 0 Boundary Line Adjustment 0 Modular ❑ Short Plat** Commercial* [I Binding Site Plan** ❑ Change of Use 11 Long Plat** ❑Address i i Road Approach Li Planned Rural Residential Development(PRRD)/Amendments** ❑ Propane ❑ Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions** 0 Stormwater Management ❑ Shoreline Management Substantial Development** 0 Site Plan Approval Advance Determination(SPAAD)* 0 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 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 n''required later inspectio s.Acce and right of entry to this property shall be requested and shall occur only during regular business hours. J Signature: (cAA..,) t. , ce Date: v S 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' you are in compliance wi h the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-trap ab responsibir for erin t nd complying with the ESA. The Applicant has read this ' 'mer a Si -and dates it below. Signature: c (!/CA Qa '1��----_ Date: �� "3/ C G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc • I 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 a i�miii�ng the responsibility f e ral Contractor for the proposed project. Signature: lam/( C��-�. e4.. �- Date: ,` `�/fC= 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 Wood Existing: 3 ci Li Sewer ❑ Addition ❑ Steel Proposed: — Bank ❑ Community System Alteration/Remodel Cl Concrete Total: Height: 'Individual System Cl Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: 3 Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed:Total: ( -7 ' X Public 6Nam9 of System: Ccp- 6 e t vt%` Cdl'1 Li-2 14ci t_2_2.Y 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_I Underground Tank I 1 Above ground Tank Size of Propane Tank: i_i Heat Stove I i Cook Stove ❑ Woodstove I I Fireplace Insert 1 i Hot Water Tank i i Pellet Stove F 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:NO i_.,A_ - 2""Floor Base fee: . Si '75 3rd Floor Additional Section: (Q ,t Mezzanine. r� �}_ I r �� Plan Check fee: /, �� !td r Cetai n ctlik'�,.kC+ic kl " .7 1 Heated Basement' / �1 q Z �.� ,�3�I State Surcharge fee: Unheated Basement 4X,St' - t Pot Water Review fee: $ 3.-1 Other Unheated 911/Rd Approach fee: P Garage/Carport TOTAL: $ I l 1-1(e rI Decks �i Q Receipt Number: ' '3 ,3 Other Cash/Check Number: 3 I . ES ATED COST(REQUIR D) Date:/•Fair market value of all labo?end materials foundation to finish 62 13 16 5— ( it -3 Initials: 2.5 C *7-efrienterAF RD FORMS\Master Permit Application 7-8-04.doc