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HomeMy WebLinkAboutBLD2006-00564 MLA06-00542 ILDING PERMIT APPLICAT. Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00564 Received Date: 9/29/2006 SITE ADDRESS: 181 OLD BRINNON HWY BRINNON, 98320 OWNER: JIGUANG ZHANG PHONE: (206) 365-3047 CHUNNI DUAN 2811 NE 185TH ST LAKE FOREST PARK WA 98155-4142 SUBDIVISION: Block: Lot: TX14- PARCEL NUMBER: 502112019 Section: 11 Township: 25 N Range: 02 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTION CONVERT CARPORT INTO GARAGE AND PLAYROOM REMODEL EXISTING BATH IN HOUSE BY ADDING SHOWER TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP ADD MAIN: 200 VALUATION 21,363.00 ADD'L: HEAT TYPE: EEE CODE EDITION: 2003 HEAT BASE: HEAT TYPE: OCCUPANCY: OCCUPANCY: UNHEATED: # OF STORIES: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: 250DECK: 60 SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: PWELL BEDROOMS: BATHROOMS: Exist: 2 Exist: 2 Prop: 0 Prop: 1 Total: 2 Total: 3 Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $349.25 KAS 09/29/06 84893 Plan Check $227.02 KAS 09/29/06 84893 State Building Code $4.50 KAS 09/29/06 84893 Total: $580.77 �gON co • • �!_'f"`� ^� ' I(� I( Al G� JEFFERSON COUNT'( t 1 W 'A'; 4,3 DEPARTMENT OF COMMUNITY DEVELOPMENT '' - '' 621 Sheridan Street• Port Townsend • Washington 98368 • f1 360/379-4450 • 360/379-4451 Fax -'` it., Gip www.co.jefferson.wa.us/commdevelopment N -y C-61 4 b — 71 i — F!7 731 Af li i CRP( I1.i Master Permit Application a MLA: .P Project Description(include separate sheets as necessary): Gt-tc4 re U C.1 C ) _X I 'S f"- IJ c'-, +-1-, %::7,; ,_, by t/ Co><1uert Cc rporfi l 'ik- 6G.Y eke_ cl ncl 13iozy [ m Ci� S he i.:�-e✓ ` Property Tax Parcel Number: C. O Z) 1 ZO t(" Size: s Z-t 2$u (acres/square feet) Site Address and/or Directions to Property: 1 8) 0 la k( v Y1 C►1 Hwy , i'Y 1 h r1 p rl , to A I's j Z c Property Owner(s)of Record: 31C?U/tiJ Zi-i PrN 4 / Ci-4 U/4IJ I Do ry Telephone: ?A 6 °-17b 5— 3 4-1 x Fax: '2.a6 aS-' 344 email: 3tIw74,-at 1 ail Ci1'Iot^. ct01 Mailing Address: 2.—S3 (I (J E 18 5+'1 S+. , LIN Ke Fe/LES i PAgg i w A i S' Applicant/Agent(if different from owner): Telephone: Fax: email: - Mailing Address: What kind of Permit?(Check each box that applies) I Building I Variance(Minor,Major or Reasonable Economic Use) I Demolition Permit I Conditional Use[C(a),C(d),or C]** I Single Fa I Discretionary"D"or Unnamed Use Classification VGarag Attached/betached I Special Use(Essential Public Facilities)** I Manufa wd I Iu Ie I Boundary Line Adjustment I Modular I Short Plat** I Commercial* I Binding Site Plan** I Change of Use I Long Plat** I Address I Road Approach I Planned Rural Residential Development(PRRD)/Amendments** I Propane I Plat Vacation/Alteration** I Allowed"Yes"Use Consistency Analysis I Shoreline Master Program Exemption/Permit Revisions** I Stormwater Management I Shoreline Management Substantial Development** I Site Plan Approval Advance Determination(SPAAD)* I Shoreline Management Variance I Temporary Use I Comprehensive Plan/UDC/Land Use District Map Amendment I Wireless Telecommunication* i Jefferson County Shoreline Master Program Amendment I 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. /_ I /'� /7 /�� ,,. C�, Signature: `b l�C...�-� Ni—C-`--spate: / 1 J -i o 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- transferab sibility for adhering t nd complying 7itt,eSA. The licant has read this disclaimer and signs an d�ateis it below. Signature_ 1,^/ Date: 1 I A / 41-6 V C:\Documents and Settings\carat\Local Settings\Temporary Internet Files\OLK8S\Master l'crmit Application 12-30-05.doc • BUILDER STATEMENT Y a' }'� iF �r41t, rs nd The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they -I a se contractors and that they will be ass • g the responsibility of the General Contractor for the proposed project. `/ �� Signature. u C ' Date: (2r S-7° C R 9 2; GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: IMP f)1., MAILING ADDRESS: EMAIL: CONTRACTORS LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: t.Me 4y Ry n "i.A , \ ►I"kGf- PHONE 3 'c.)7qt--34_ffq FAX:(344,) 1`(6-34' et MAILING ADDRESS:4,{( p/c?tt,cnmf NGrb4Jr (p 4., , rinncn AIL wYyanc.r('hi-i-etf ,.-- &Ir*It:,k. tier Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New l9'Wood Existing: l •C '❑ Sewer teAddition 0 Steel Proposed: . -S Bank Height: ❑ Community System ❑ Alteration/Remodel 0 Concrete Total: i t 7 S , '8individual System 0 Repair 0 Masonry SEP Permit# ❑ Demolition 0 Other: Bedrooms: Water Supply: Existing: Z Setback: 'r Private well ❑ Two Party Type of Heat: Proposed: �_ O i ❑ Public CrI�Cj'Y1'C •�[tt1 Total: 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: I Underground Tank 1 Above ground Tank Size of Propane Tank: I Heat Stove 1 Cook Stove I Woodstove i Fireplace Insert I Hot Water Tank I Pellet Stove I Other Is this appliance being installed in a Manufactured`1 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 Pro•osed Fo Office Use Only Amount Revision Main Floor Heated --'',\ ° t,!EH Bid App Review: Svo 20ct �,/�� 2na Floor Heated N _Consistency Review: ���W sap 1470- 1305(00) 155-D5 Other Heated Base fee: Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport � - SUBTOTAL CFDo 2S6 5 gip,5u —1qG D ,7 Decks ,� 911/Rd Approach fee: Z5° r Ik ,k `o1AA9-- Ii- Other ,m i� . .t4 I ,ZC7 TOTAL: $ qc, -7- _ ex, Receipt Number: 3 Cash/Check Number /4 - ESTIMATED COST(REQUIRED) Date: q a� .Fair market value of all labor and materials foundation to finish l 0 Initials: $ ) 7 „00V$ I ,oom ► M 0 ECG -T� C:\Documents and Settings\caral\Local Settings\Tempora :1cs\O1.K aster Permit Application 12-30-05.doc ,a0 I a.—t 0 1— t r Gc)51 D(►?(c) .7() 66b£-96L(09£):xe} 1£-96L(09£).auoyd r 7,1OZ£86'uo�6uiysee'uouuu b Jogjeu aueseald I I b uo (em 6i uouuu 1�111 ND1b `NVA Aa NAM Uo ��ppd asnoNy u�na9 O6u��Z o N c r,» z O N O u O L....! 5 ;�14 z (244 W4.J u, O s $ I)4. 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P: I } Dd 2S149 o n L..--....D. 99 V3 qua C ' _ - �.. SEC. 2 BY ROATS ENGR. (/86-6550) k 1 1 ;1 'fir► 181 OLD BRINNON HWY BLD06-564 ZHANG/DUAN MLA06-542 Approvals Req'd Phi) (IaN\�� :)S !o Final Inspection aDa SEP RAP ?4N .: IPZ DPW / ( cia/Lcka.i2_6‘,_ lh