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Home My WebLink AboutBLD2005-00449 • • BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD05-00449 Received Date 07/12/2005 SITE ADDRESS: 2281 HASTINGS AVE W Issue Date 07/15/2005 PORT TOWNSEND, 98368 APPLICANT: BERNT P ERICSEN PHONE: 360-385-4281 MARLENE J ERICSEN 2323 HASTINGS AVE W PORT TOWNSEND WA 983689286 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001054009 Section: 5 Township: 30 N Range: 01 W CONTRACTOR: RJ KEDS ENTERPRISES, INC PHONE: 360-301-0889 2123 W SIMS WAY PORT TOWNSEND WA 98368 Contractor's License: RJKEDEI055KK Expires: 12/13/2006 PROJECT DESCRIPTION: CHANGE OUT WINDOWS 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: Plumbing: Propane Tank/ Lines: Insulation: Sheetrock: Septic Sytem Final Approval (If not on sewer): Road Approach Final Approval: PFinal Approval:')- upancy Approval: itae ALTH DEPARTMENT AND PUBLIC 0 KS 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 1 0/29/1 999 •UILDING PERMIT APPLIC N BLD05-00449 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD05-00449 Received Date: 7/12/2005 SITE ADDRESS: 2281 HASTINGS AVE W PORT TOWNSEND, 98368 OWNER: BERNT P ERICSEN PHONE: 360-385-4281 MARLENE J ERICSEN 2323 HASTINGS AVE W PORT TOWNSEND WA 983689286 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001054009 Section: 5 Township: 30 N Range: 01 W CONTRACTOR: RJ KEDS ENTERPRISES, INC PHONE: 360-301-0889 2123 W SIMS WAY PORT TOWNSEND WA 98368 Contractor's License RJKEDE1055KK Expires 12/13/2006 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION CHANGE OUT WINDOWS TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP ALT MAIN: 0 VALUATION 4,500.00 ADD'L: 0 HEAT TYPE: EEE CODE EDITION: 2003 HEAT BASE: 0 HEAT TYPE: OCCUPANCY: R-3 UNHEATED: 0 # OF STORIES: OCCUPANCY: OTHER: 0 CONST TYPE: 5N GARAGE: 0 SHORELINE: CONST TYPE: DECK: 0 SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: 0 Prop: 0 Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: .A PR - E C . State Building Code $4.50 SLE 07/12/05 73472 Plan Check $72.31 SLE 07/12/05 73472 JUL 1 5 2005 Permit $111.25 SLE 07/12/05 73472 Jefferson County Planning Total: $188.06 & Building Department (;oA.vN ae �_ • • r 4;1 ,3i I e — o a- C"07.D, @t +:) \pA 144o 0 o V w3 7 `,../Yza... c O ,z� .� , to Viii it-_, 3 4f -,-7 N O L O O �n tt " a) v�io E .. 2 O AwlN p O Ile i a 41 <xi T:T) cti = ,,... . „..„. i ".., M —re _ cD a) -0•mow .. CO �' v" Q b , ILMO) 0 N C ti) PI 0 -. 4..,, GI i • • k. 0 �- I :fir03 E b al (10 NI L 1 d > CV ON /1�� CD OL 0) di �. L - O C \ t O L O 0 '' °' ° ° 30 �I1N1103 NOS0111 2 2005 Nc0C � OO 4 JUG O d~ 1______-7---r-7--- . o) uu) p 3zE i/ O - O xacDEEE ,, a5 a18 # 11 __ - PNLfEE WN3d .zt3EEE 1 __ SON, e � � . , I.. �'., ��, �' t.: � � - r o& JEFFERSOF OUNTY.,r ' ��o �� DEPARTMENT OF COMMUNITY DEVELOPMENT JUL , 2 621 Sheridan Street • Port Townsend •Washington 98368 { g , 360/379-4450 • 360/379-4451 Fax �q�, �0� www.co.jefferson.wa.us/commdevelopment JEFFERSON COUNTY `(_CPT. OF COMMUNITY DEVELGpME, , Master Permit Application MLA: 'Ins QF( ut12. (J Project Description (include separate sheets as necessary): Ctb i6 L)/wbetvs . Tax Parcel Property Number: Size: (acres/square feet) Site Address and/or Directions to Property: '' Property Owner(s)of Record: Telephone: 1<= ., Fax: email: Mailing Address: Applicant/Agent(if different from owner): • Telephone: ( 1 — `/ Fax: . I 'IN email: Mailing Address: 7 /Z 3 I, e, ,i / i ` 1 What kind of Permit?(Check each box that applies) lKBuilding .'+,R ❑Variance(Minor, Major or Reasonable Economic Use) // ``❑ Demolition Permit ❑ Conditional Use[C(a), C(d),or C]** ONSingle 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 ❑ Long Plat** ❑Address 0 Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** ❑ Propane ❑ Plat Vacation/Alteration** ❑ Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions** Li 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 /t=h ti 1 e f c-N•v 4- to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE 1 ,: t � �� 4,L.C4411 7"12 4•i 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 required later inspections.Access and right of entry to this property shall be requested and shall occur only during regular business hours. j�1 t- J / )�A Signature: E 7/G el-t iE-t -c-- .- /1,4 I f` Date: //( 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-transfer le responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: -i �,j L( `C "it /.4ii�_ `7—i 2 -l:i Date: G:\PermitCenter\FORMS\DRD FORMS\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 the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: 1 jam` L A., %� IL l'ti t ( ) ( ) :' )`i fj / 11.' MAILING ADDRESS: / t 2 S t EMAIL: It i CONTRACTOR'S LICENSE WAINS NUMBER: t NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New .• • Fd' Wood Existing: i] Sewer 0 Addition ' i ; 0 Steel Proposed: Bank I I Community System 'g Alteration/Remodel 0 Concrete Total: Height: (! Individual System 0 Repair 0 Masonry _ SEP Permit# Seci EI ❑ Demolition ❑ Other: Bedropmss, IF' (? ( ' Water Supply: Existing I )) L. Setback: [I Private well 0 Two Party Type of Heat: _ �tal: 11 1 j ❑ Public Name of System: L�c -� ...Propose&L JUL12 200-14 I , Cu If this is a Commercial Project you must answer the follow ng: JEFFER„Gty c. , CO UN I TY Number of Parking Spaces: Current: ProposikfrT. OF COMm!1',!T'NDmIT@CADA arking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current ►'roposed 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 1 Underground Tank I i Above ground Tank Size of Propane Tank: I i Heat Stove I I Cook Stove I 1 Woodstove I 1 Fireplace Insert I 1 Hot Water Tank I I Pellet Stove L! 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: 3fd Floor Additional Section: Mezzanine: Plan Check fee: Heated Basement State Surcharge fee: Unheated Basement Pot Water Review fee: Other Unheated 911/Rd Approach fee: Garage/Carport TOTAL: $ i. Decks Receipt Number: 7 341 z Other Cash/Check Number: `OG ESTIMATED COST(REQUIRED) Date: I,, `If�S •Fair market value of all labor and materials foundation to finish t Initials: c29R2 G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc