HomeMy WebLinkAboutBLD2005-00389 Page 1 of 1
•
Colleen Zmolek
From: Zoe Ann Lamp
Sent: Friday, December 14, 2007 3:34 PM
To: Colleen Zmolek
Subject: Cancelled Permits
I cancelled the following pending permits due to lack of action.
BLD04-00771 - Steve Carlson - ;n L Pt c 4 (41
BLD05-00028 - William Garrett L : b — ) --3
BLD05-00389 - Michael DeMars MLA- 05 - 3(Q
Sincerely,
Zoe Ann Lamp
Associate Planner, DRD
Jefferson County Department of Community Development
621 Sheridan Street
Port Townsend, WA 98368
Phone: 360-385-9406
Fax: 360-379-4473
e-mail: zlampCa�co.jefferson.wa.us
All e-mail sent to this address will be received by the Jefferson County e-mail system and may be
subject to Public Disclosure under Chapter 42.56 RCW.
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12/14/2007
lit Review UILDING PERMIT APPLICASN ML Review Ty 364
ype: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD05-00389 Received Date: 6/13/2005
SITE ADDRESS: HILL ST
PORT LUDLOW, 98365
OWNER: MICHAEL B DE MARS PHONE: 360 437-2477
3611 PARADISE BAY RD
PORT LUDLOW WA 983659255
PARADISE VIEW ESTATES
SUBDIVISION: Block: Lot: 5
PARCEL NUMBER: 984001203 Section: 22 Township: 28 N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOt Install Metal Container as Unheated Storage
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 408
VALUATION 9,617.00 ADD'L: HEAT TYPE: UH
CODE EDITION: 2003 HEAT BASE: HEAT TYPE:
OCCUPANCY:
OCCUPANCY: UNHEATED: #OF STORIES:
CONST TYPE: OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK:
BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 0 Prop: 0
Total: 0 Total: 0
Routing Date:
U.P 1u
Type Amount Paid Bv: Date: Receipt: Approved/Date
Permit $181.25 RAC 06/13/05 73322
Plan Check $117.82 RAC 06/13/05 73322
State Building Code $4.50 RAC 06/13/05 73322
Total: $303.57
�ggON JEFFERSOOUNTYCOMMUNITY 17)
DEVELOP ENT I fl
DEPARTME621 Sheridan Street• Port Townsend •Wa inton B j3 2005 i NT OFJ
360/379-4450 • 360/379-4451 Fax
�qs 4,JOB www.co.jefferson.wa.us/commdevelopmen
NG JEF Utr J
Master Permit Application M - (1. i
Project Description(include separate sheets as necessary): - ut,
Tax Parcel y$C/04 i 2a:3 �� A Perty
f ]L S-r ,4Gf f'oirro /AICl
Number: 9 g Yco 1Z0 2f Size: zo (acre quare fe t)
Site Address and/or Directions to Property: U/f i F . (w y�%rr]'((�-�i i o r7 i[�--ST
Property Owner(s)of Record: /7/f'4Oci /7 IJl7 "-/
Telephone: 4/3 r?-2 y9 7 Fax: email:
Mailing Address:_ •
Applicant/Agent(if different fr m owner):
Telephone: Fax: email:
Mailing Address:_
What kind of Permit?(Check each box that applies)
Building ❑Variance(Minor,Major or Reasonable Economic Use)
❑ Demolition Permit D Conditional Use[C(a),C(d),or C]**
0 Single Family ❑ Discretionary"D"or Unnamed Use Classification
❑Garage Attached/Detached 0 Special Use(Essential Public Facilities)**
❑Manufactured Home ❑ Boundary Line Adjustment
❑Modular D Short Plat**
0 Commercial* 0 Binding Site Plan**
0 Change of Use ❑ Long Plat**
❑Address ❑ Road Approach 0 Planned Rural Residential Development(PRRD)IAmendments**
❑ Propane 0 Plat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions**
0 Stormwater Management D Shoreline Management Substantial Development**
❑ Site Plan Approval Advance Determination(SPAAD)* D Shoreline Management Variance
❑Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment
D 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 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 acrpas 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 andtgtfall occur o ily'during regular business
hours. Q
Signature: J s •_! IQ
i tya Date: -- -"OS
r
The action or actions scant 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-transfera le responsib'ity for adhering to and complying with the ESA. The Applicant has read this di clai er and signs and dates it below.
Date:
Signature: — -7-OS-
G:\PermitCenter\FORMS\ ORMS\Master Permit Application 7-8-04.doc
• 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 ttte General Cant actor for the proposed project.
t Signature: . F.�!!'i: I'�: I �- Date: tel- !- OS--
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
tNll o(LSW ) ( ) ( )
MAILING ADDRESS: + i EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER --
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Pfoject Type: F me Type: Bathrooms: Shoreline: Type of Sewage Disposal:
ICJ New ❑Wood Existing: MAIL-.
❑ Sewer
❑ Addition E] Steel Proposed: Bank ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System
❑ Repair ❑ Masonry SEP Permit# NO1t�
❑ Demolition ❑ Other: Bedrooms: I , Water Supply:
Existing: N 0M--- Setback: ❑ Private well ❑ Two Party
Type of at: Proposed: ❑ Public
tV Total: Name of System: MOO—
If this is a Commercial Protect 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:
❑ Underground Tank ❑ Above ground Tank Size of Propane Tank:
❑ Heat Stove ❑ Cook Stove ❑ Woodstove ❑ Fireplace Insert ❑ Hot Water Tank ❑ 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 Only
Current Proposed Amount
Main Floor C Cogsistency Review:
2""Floor `�,� Base fee:
3`°Floor Additional`Section: 1
Mezzanine: Plan Check fee:
t t ,l%�
Heated Basem 72,,'. :7
.�. „ _ State Surcharge fee: � ._
, ::,iit,,
1 r. tr.,, ,, 1 ,, „
Unheated Base end' --:_k .Li `' l ( Pot Water Review fee: }
fi ,i� i
Other Unheat j 1 I I U 1 3 � t`j 911/F d ApProac1lt flee: I ' :::' '''''.:: ,
�j
Garage/Carpo TOTAL $ q +
JEir ' f'1 Jit` �e r
Decks r,�: :, w
cl CI r I,. k. ; I IFt r r tiR �.;' Receipt Number.
Other CashiCheck Number: 4
ESTIMATED COST(REQUIRED) Date: c--
.Fair market value of all labor and materials foundation to finish II 1",)I L
gab toCJ Initials: {
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
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