HomeMy WebLinkAboutBLD2005-00477 •
BUILDING
ILDING PERMIT APPLICATJ ML ReviewTy 442
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD05-00477 Received Date: 7/21/2005
SITE ADDRESS: 262 MARGARET ST
PORT LUDLOW, 98365
OWNER: STEVEN G METCALF PHONE:
REGINA B METCALF
123 2ND AVE SW
EPHRATA WA 98823
SUBDIVISION: Block: Lot: T 81
PARCEL NUMBER: 821333028 Section: 33 Township: 28 N Range: 01 E
CONTRACTOR: PHONE:
PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr ADDING TO EXISTING DECK
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP DEK MAIN:
VALUATION 5,775.00 ADD'L: HEAT TYPE:
CODE EDITION: 2003 HEAT BASE: HEAT TYPE:
OCCUPANCY: R-3 UNHEATED: # OF STORIES:
OCCUPANCY:
OTHER:
CONST TYPE: 5N GARAGE: SHORELINE:
CONST TYPE: SETBACK:
DECK: 245
BANK HEIGHT:
SEWAGE DISPOSAL: CON _
WATER SYSTEM: PWELL
BEDROOMS: BATHROOMS: ,
Exist: Exist:
Prop: Prop:
Total: Total:
Routing Date: J Q l )6C~�
Type Amount Paid By: Date: Receipt: Approved/Date
Plan Check $81.42 SLE 07/21/05 76190
Permit $125.25 SLE 07/21/05 76190
State Building Code $4.50 SLE 07/21/05 76190
Total: $211.17
• ,. .
Sept. 18, 2005 ¢ . 44.
Steven G. Metcalf
123 2nd Ave. S.W.
Ephrata, Wa98823
Re: Site Address: 262 Margaret St
Port Ludlow, Wa
Case#: BLDG05-00477 rg/U12:4/
Jefferson County Department of Community Development, Al Scalf Director:
After further review of the permit process, costs, and the complexities of our unique r
residential area; we would like to withdraw our application for building permit
#BLDG05-0047. Would you please forward any refund of fees or taxes due us at this
time from our original payment? �CF
At this time we would like to compliment you during our applications, contact with your 0 c—
offices, and personnel associated with the Jefferson County Department of Community
Development. My wife and I are new to Jefferson County and were unfamiliar with the
building and permit process. Your staff was friendly, helpful, and of good nature when
working with our `beginner' knowledge of our intended project. Q,P�
Thank you all for being fair and honest as you gave us your expertise and assistance. We 1/1
look forward to years of the wonderful lifestyle in Jefferson County and co-operative, r 1 1.
:r
helpful people like you.
Sincerely,
) ReinaMetcaif
��. `¢, oiv Dora• JEFFERSON C�JNTY r al
a DEPARTMENT OF COM , DErrOPM
621 Sheridan Street• Pert +wrtseiti •Washirigto
360/379-4450 • 360/37", • ' . ax
11,
0 www.co.jefferson.wa.us corn development
�S�trrr�`� J U L 2 1 2005
Master Permit Application ! MLA: C) 5- '14_
Project Description(include separate sheets as n Fiv n
Tax Parcel Property /00' c '2 Co`
Number: `3 / 'i`5 R7 c i' Size: :Z C=C?C.,(7) Sg!T. (acres/square feet)
Site Address and/or Directions to Property: %. r`?4.A y..1, e f i�, % ;7 pt e,;o• 4,. r✓ei,�{
Property Owner(s)of Record: _ :�U�.ec/ c. .Y c>9'% A?. t'"(e T e1 414
Telephone:"C%��- ?% - ('' r ( C'`-,;�/Fax: 1 7- �77—` 9(;� email: d�""---. L--'/ -
Mailing Address: t'-7.7 '7 ct'�, ,!j` .tv !_ "/!!"r`i � � �,�'` '
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies)
U,Building '/'C I ❑ 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 ❑ Long Plat**
❑Address ❑ Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments**
❑ 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:
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 required later inspections.Access and right of entry to this property shall be requested and shall occur only during regular business
hours. ll,�,, �/ _
Signatur,• ,'`4/t'�- /1 Date: L' �"}
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 a responsibly#y for,apherin to and complying with the ESA. The Applicant has read this disclaimer and signs anc)ates it below.
Signatur 4.- ---:-" fs Date: 2
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
iiOWNER 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 ass miinng the responsibility of the General Contractor for the proposed project.
Signature*6��%f✓L/ � �L` i ' Date: e-—'7.— �'
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:
S. New [p-Wood Existing: 0 Sewer
R Addition ❑ Steel Proposed: - Bank ❑ Community System
R. Alteration/Remodel ❑ Concrete Total: Height: 63 Individual System
j-,.
❑ Repair ❑ Masonry SEP Permit#cvc:--=—f?=�,
CI Demolition ❑ Other: Bedrooms: Water Supply:
1-�Cc r< Existing: Setback: I Private well 0 Two Party
Type of Heat: Proposed: ❑ Public
Total: Name of Systen)y_
?Xiiw' i ,.^t 1 Aele c
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:
❑ Underground Tank ❑ Above ground Tank Size of Propane Tank:
Li Heat Stove ❑ Cook Stove Li Woodstove Li Fireplace Insert ❑ Hot Water Tank 0 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 Use Only
Current Proposed Amount
Main Floor Consistency Review:
2Nu Floor Base fee:
Su Floor ' 1� Ii !.., i -Additional
Mezzanine: \I Plan Check f f
' ' J U L 2 1 2005 {,. ) I ? .
Heated Basement State Surcha a fee: r_
i. i '-. �`
—
I • i
Unheated Basement ,' r'I a Pot Water`Revievl� e:
i,,:, ,,
Other Unheated 911/ftd Approac `fee:
Garage/Carport ?- "I " ,
Ci/�/�'0rf -a t, TOTAL f
Decks 1, 5 n !2• .4 r_- j -
/ie'``i i.e0 ' 1 .✓Z'�V-� Receipt Number: ,— , (!
Other Cash/Check Number
J-t
ESTIMATED.COST1RQUIRED) Date: ��. � r
'Fair
rmarket value of all la,(3pr and mOnals foundation to finish - ii 1 I J
1. ((J +.�i :/ q 9J � Initials: ` 1r
�N`
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
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