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HomeMy WebLinkAboutBLD2006-00315 93 ILDING PERMIT APPLICATI Iv MRAOWOOpe2: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00315 Received Date: 6/6/2006 SITE ADDRESS: 505 SPIKE LN FORKS, 98331 OWNER: GLEN J HART JR PHONE: 425-335-4044 KATHY A HART 505 SPIKE LN FORKS WA 983319510 SUBDIVISION: Block: Lot: PARCEL NUMBER: 612042006 Section: 4 Township: 26 N Range: 12 W CONTRACTOR: TIMBERLAND HOMES PHONE: 1-800-488-5036 1201 37TH NW AUBURN WA 98001 Contractor's License TIMBEH*2090B Expires 8/27/2006 REPRESENTATIVE: GRETCHEN REYNOLDS PHONE: 206-592-1824 3058 S 200TH SEATAC WA 98198 PROJECT DESCRIPTIOI NEW MODULAR HOME TYPE OF WORK MOD SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 2,096 VALUATION 54,496.00 ADD'L: HEAT TYPE: EEE CODE EDITION: 2003 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: # OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: PWELL BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 2 Prop: 2 Total: 2 Total: 2 Routing Date: (O lc Type Amount Paid By: Date: Receipt: Approved/Date Permit $678.75 LYK 06/06/06 83502 Plan Check $441.19 LYK 06/06/06 83502 State Building Code $4.50 LYK 06/06/06 83502 Potable Water Application $55.00 LYK 06/06/06 83502 Total: $1,179.44 • • JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT REFUND REQUEST/POSTING MEMO DATE: IN The amount of 543'° received from /1� lPfl cr Ka...+1-19 1 r4, for(case#) f5L )0(c,- is to be refunded to: qien pc- ,<o j-h t-40,4 c3D5 DLL£. LAr`� k �sWk933I as a result of: (ICY-V.-El lEr) (rr-)MC" Date&number of original receipt: REVENUE FUND CODE NO. REVENUE SOURCE NAME AMOUNT 143-000-010 322.10.00 BUILDING PERMIT APPLICATIONS BLD 5434 n 143-000-010 322.40.20 ROAD APPROACH PERMIT APPLICATIONS RAP 143-000-010 322.40.30 UTILITY PERMIT APPLICATIONS 143-000-010 322.40.80 ADDRESS FEES 911 143-000-010 334.04.20.20 CTED GRANTS 143-000-010 341.50.00 SALE OF MAPS&PUBLICATIONS PUBS 143-000-010 341.60.00 DUPLICATING SERVICES COP/DUP 143-000-010 345.81.00 SUBDIVISION APPLICATIONS 143-000-010 345.81.10 CAMPER CLUB APPLICATIONS 143-000-010 345.81.20 SHORELINE SUBSTANTIAL DEV.PERMIT APPS 143-000-010 345.81.30 CURRENT USE TAX ASSESSMENT APPLICATIONS 143-000-010 345.81.40 ZONING APPROVAL APPLICATIONS 143-000-010 345.81.50 CRITICAL AREA REVIEW CAR 143-000-010 345.81.60 CONVERSION OPTION HARVEST PLAN COHP 143-000-010 345.83.00 PLAN CHECK FEES 143-000-010 345.83.10 FIRE MARSHALL PLAN REVIEW 143-000-010 345.89.00 ENVIRONMENTAL REVIEW/SEPA 143-000-010 346.22.30.40 DCD Water Review 143-000-010 359.90.60 SHORELINE VIOLATIONS 143-000-010 359.90.65 BUILDING CODE VIOLATIONS 001-250-000 369.90 MISC TREASURER REV-BAD CHECK FEE 127-000-010 346.22.30.10 HEH523 WATER AVAILABILITY FEES H2O 127-000-010 346.22.30.10 HEH541 LIQUID WASTE FEES SEPTIC 127-000-010 346.22.30.10 HEH545 EES 3RD Party Inspector Report Filing Fee 127-000-010 346.22.30.10 HEH582 SHORT/LONG PLAT FEES 127-000-010 346.22.30.10 HEH549 SEP Other 0/5 180-000-010 322.40.50 RIGHT OF WAY APPLICATIONS 180-000-010 343.20.10 ROAD FUND 626-000-010 239.10 PLNG TRUST ACCT 650-511-000 386.00 STATE BLDG CODE FEES 659-003-030 367.13 FIRE DIST#3.MITIGATION FEES 685-049-030 300.00.00.2900 SCH DIST#49.MITIGATION FEES TOTAL REFUND 51454' Authorized person signature: Treasurer's check#: Date: Treasurer's signature: GIPermitCenter/DEPOSIT/Refund Form 12-2005.doc • • � ON c 4� 1�,� JEFFERSON COUNTY W y� a DEPARTMENT OF COMMUNITY DEVELOPMENT , '"' v rC 621 Sheridan Street • P,oiti ownsend ;..Washington 98368 9 $ 360/379-4450 • 360/379-4461 Fax i; gs, NG�p www.co.jefferson.wa.us/commdeyelgpment 100 ri' J NN 6 ii Master Permit Application • I ; MLA: v, -aci 3 Project Description (include separ to heets as necessary): i - i pa c c ne:c cocci m ax 1�1c;'t.«.. tom_ `5 e_ Hi (I M Ms-€ ► od 6r?m Property 4 lc etc Q-tr 11 C_ Tax Parcel Number: (t I Z C' (i C C�-(l 4 , riL (( ^`- Size: (acres/square feet) Site Address and/or Directions to Property: '3C' `7 t I� (..-eU C '1 % For%S CC '>j l Property Owner(s)of Record:0 ) f[ 4z 1,1 /-- Telephone: 31.25 . ?i ,i) `f{'y4 Fax: email: Mailing Address: 5C-5 ' r.ta Le( itt— rr)-rS Lt_,A 9 M Applicant/Agent(if different from owner): (Y`(-tL Nif r) j2("cyr)t?1G/S Telephone: ACV- S 7.J' f ')t Fax: 7�7' (r. /Y L/ rerlst email: ,m rts WI6?m n.Lr Mailing Address: 3O' `J� - ZOO `- Ca.-1 -c- tap C% .(i CI I What kind of Permit?(Check each box that applies) yt Building ❑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: /'l"ed-r.ier ��^ /��,i_( DESIGNATION OF AGENT I hereby designate, t y to act as my agent in matters relating to this a plication for permit(s). OWNER SIGNATURE �-(_t' bt, /4 Date: -9/78�� By signing this application form,t4�wnerF/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 r/quirpdd/later inspections.Access and right of entry to this property shall be requested and shall occur only during regular business hours. « 1�� �® Signature: - 'ry Date: z/Z<f 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 he Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non- transferable re ns. 'ity fora rin/g t/o r)d complying with the ESA. The Applicant has read this disclaimer a7nd 7wi.wd dates it below. Signature: (`i ' Date: 2 66 . • • BUILDER STATEMENT The signer of this statement does hereby certify thyt they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assumjn the r sponsibility of the General Contractor for the proposed proje , i' / Signature: f 4 '1— r/ Date: 7-"/ L- /lCi GENERAL CONTRACTOR 0 M `t�UFACTURED HOME INSTALLER: PHONE: FAX: 1 i'I-rl{�'t 1C�ri ( 1�rr)2C3 /rtL (;,`) 7 2 . /l>5 (_ 7.- ) MAILING ADDRESS: 7'i ,4 4,heccri EMAIL: CONTRACTOR'S LICENSE J� I WAINS J L2.ci Will Y') NUMBER: Ti I11 A Hit?2-0`7()%) NUMBER r;t1A-i 0`a 0(oL 1 ARCHITECT/E IGIkEER Pa t 1 3i f ref 1 / PHONE (,95'3 ).,"j(� _� it FAX: ( ) 5- '8/'j7 MAILING ADDRESS: . t ;}-1 11'11Y iC/1a' —C< :' _,tr l,i EMAIL OGti� ( i"rf II� 41r,�if Project Type: Frame Type: Bathrooms: Shoel'ne: Type of Sewage Disposal: If New Wood Existing: 14 ❑ Sewer © Addition ❑ Steel Proposed: - Bank Height: ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: 0 - ,_Individual System t�67 f Ca ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: (7 Water Supply: Existing: Setback: vq Private well ❑ Two Party Type of Feat: u.la,(" Proposed: c3- [I Public � (�►� Total: .4-. 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: Li Underground Tank I 1 Above ground Tank Size of Propane Tank: ❑ Heat Stove ❑ Cook Stove I 1 Woodstove [i Fireplace Insert V Hot Water Tank ❑ Pellet Stove LI 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 Current Proposed For Office Use Only Amount Revision Main Floor Heated gcfitx, 54 EH Bld App Review: tto5 ao 2"°Floor Heated Consistency Review: t+ ,5cu Other Heated ...er- Base fee: r7 Cn f8 Mezzanine Additional Section: Heated Basement Plan Check fee: ,{ OA Unheated Basement State Surcharge fee: ,re Other Unheated ..r Pot Water Review fee: q Garage/Carport SUBTOTAL Decks c911/Rd Approach fee: Other TOTAL: $ i 1-1 5,g. 44 Receipt Number: ' .3 .. 04,0 Cash/Check Number: �,� ESTIMATED COST(REQUIRED) �___ '�^� Date: ram, oL(o���, 'Fair market value of all labor and materials foundation to finish w �I`'�- Initials: 1(1u:OaiAbr 11‘ViOV C7b / _ — 2'-0= 7-0 ! — 14.-O — — — --N- i4,-0, A A O ON.f-7 0 0� Iler / 7-0 -0 f kt 4 +++��� •p oIn Z y xi E 4°4°5L BENCH SEAT 4°40 51 a �y cn C m (TEMP) W/HI TOP (1 ) I :3 n f n Rl ut .b $ r N*4v A m Di r >N y v N 1 r cn a, pi rrn ^i 0—1 NODS \ N fI�1N = r Q =_WAN 1 I I Q \�� \ 75 - Nz z5C Z 0 \ Nr ?Q I I V 7-O'f o 8 a� § L 7 nil". 9 8'— 3'-7 5• s'9 I/7- si 7-9• -9' 7-l• �2 \ P`77 - 1 11, t 0 p 16'PANT 5FLV5 / o 1������ `N `N` -``-; 1 ts 0. 9 1 . ss•ovEN ir, ,G,1�I z N z lO� '-7 ` MICRO IL eJ� L 1 o m o �\ ,„,:,,v ,,�< 6/0 B{� G 36•LP COCKTOP / Fil gm 6 C rZ2x��, \ c t. o�A: v� n� -1 I Arc NI I N�xfN 8CD ti •, PI Cn C It _ \ W p \ / vo b o 6' Pcmpvz K _4 cx 7-41/2' k N'g, \''vr 1 y _ �r �r V r,s4 - I $ I I $ 1 ry F $H x, cp 2 s 1 I _ M\ 4 N o 4.-2' • 11,1 \ 12'EATING BAR 6; 10 1 ''' ° : W Lw c -'-fly,3 � .n \o '� \ \ xl�*1 F C) (y \ 1 1 S r. .,. =A r a os z o i� L ig Li.: 1 -4 DD : Or Ito p ?ut # riot O I — ! /—\ d m1 /— NI N O it 4g — — — — 5040 SL l>. r0 T 1. \a s ; . ` 41111 x i i �.oti5/O EP •• ) \ I ) r RC5 yu N. _CLO5ET NRt5 N 0'/- 0 33/0BBF ` T,5a. > (A if 17 o.y , —i I �q _ ,v �..,-0,�i�__*_ -7. g;1 - — — r; , < —< __I__ ____ ____ _ 1 0_.... _... _i_ ____ i _ :_i_ _ ///:.jr' Q, _ ..._ I 2-0. 9-6 I/2 '�7-7 '\ I p N I m I / s. 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