HomeMy WebLinkAboutBLD2006-00647 41RUILDING PERMIT APPLICAPON MLLA0600627
Review
Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD06-00647 Received Date: 11/15/2006
SITE ADDRESS: W ISLAND VIEW AVE
PORT TOWNSEND, 98368
OWNER: TOMMY NORTON PHONE:
PATSY NORTON
95 N WILLISON AVE
PORT TOWNSEND WA 983682534 IRONDALE
SUBDIVISION: Block: 114 Lot: 1-3
PARCEL NUMBER: 962111401 Section: 34 Township: 30 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: ANDY ERICKSON PHONE: 360-385-4622
212 MARIETTA LOOP
PORT TOWNSEND WA 98368
PROJECT DESCRIPTIOr NSFR W/A/G 120 GAL PROP TANK
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 651
VALUATION 70,778.00 ADD'L: 400 HEAT TYPE: EEE
CODE EDITION: 2003 HEAT BASE: HEAT TYPE: WOD
OCCUPANCY: R-3 UNHEATED: 83 # OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: 5N GARAGE: SHORELINE:
CONST TYPE: DECK: 9 SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: OTHER
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 1 Prop: 1
Total: 1 Total: 1
Routing Date:
t I
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $790.75 LYK 11/15/06 86861
Plan Check $513.99 LYK 11/15/06 86861
State Building Code $4.50 LYK 11/15/06 86861
Potable Water Application $55.00 LYK 11/15/06 86861
Total: $1,364.24
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4� off. JEFFERSlOUNTY RiFiv
ti7 ' DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street • Port Townsend • Washington 9836NO 1 5 2006
360/379-4450 • 360/379-4451 Fax
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Master Permit Application MLA: 0(7- & r'7
Project Description (include separate sheets as necessary):
Property
Tax Parcel Number: C( ,-2, j i 14c,1 , Size: ,Z3ttcr4y lei t'2S -si,G.(acres/square feet)
Site Address and/or Directions to Property: C. -r Truoe L4 l`16-41d v xi—,,&Nk_ c;,t,kt tt,';I •5•:,-r ✓'ci+-i--. y.;t r >
Property Owner(s)of Record: i,n 4 0,.,A,/'{7:5y i)c w.i-r)-3
Telephone: Fax: email:
Mailing Address:
Applicant/Agent(if different from owner): i -1, t c�c: e,- 1:s *--
.
Telephone:- vim 3eiS 4t Z-z— Fax: email:
Mailing Address: BIZ- m4f re7:P< l.cvr i 4-27?_7'7-twi--6—,"'..-_,Nj ;,vA 4/t'.3i,t3
What kind of Permit? (Check each box that applies)
Building ❑Variance(Minor, Major or Reasonable Economic Use)
❑ Demolition Permit [0 Conditional Use[C(a), C(d),or C]**
y t.Single Family ❑ Discretionary"D"or Unnamed Use Classification
XGarage Attachec(/fletached ❑ Special Use(Essential Public Facilities)**
❑ Manufactured Hon.,. ❑ Boundary Line Adjustment
❑ Modular [7 Short Plat**
❑ Commercial* • ❑ Binding Site Plan**
❑ Change of Use [] Long Plat**
gAddress 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 Li Shoreline Management Substantial Development**
❑ Site Plan Approval Advance Determination (SPAAD)* C] Shoreline Management Variance
❑ Temporary Use Cl Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless Telecommunication* C]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 / �4y (Yi(_LSGYtr to act as my agent in_matters relating to this application for permit(s).
OWNER SIGNATURE 'C Q� / /7 —• �/y4�'c Date: ////'v/G)(o
By signing this application form,the owner/agent attests that the in�on 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 uired later inspections.Access and right of entry to this property shall be requested and shall occur only during regular business
hours. tom'/
Signature: 7 � � -` -CLT,%4 Date: Jl///4 6,
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-
transferable r on ibilit for erl olancom I i�ngwiitth the ES The A lica as read this disclaimer and signs and dates it below.
Signature: C y. �/G°�G C� y'/�'.� p ,---A.
Date: /1//%/C)0
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G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc
BUILDER STATEMENT 111
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 assu �,m the responsibility of the
eneral ntractorfor the oposed project.
Signature: �G.iL.�G l O?L/ a Date: /rf///i L'.
GENERAL CONTRACTOR OR MANUFACTURED HO 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:
14 New $,Wood Existing: -- ❑ Sewer
❑ Addition ❑ Steel Proposed: t •, Bank Height: 0 Community System
[1 Alteration/Remodel ❑ Concrete Total: t li Individual System
❑ Repair ❑ Masonry SEP Permit# c>kr- co t 0
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: -r' Setback: ❑ Private well 0 Two Party
Type of Heat: / Proposed: t t Public
E Ec-r t.e.. 1 w.:.c v Total: i _ Name of System: f7,-T) t
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:
IJ Underground Tank Vi,Above ground Tank Size of Propane Tank: /e. ezi- ....
. Heat Stove iii; Cook Stove ❑ Woodstove Li Fireplace Insert 0 Hot Water Tank 0 Pellet Stove Li Other
Is this appliance being installed in a Manufactured/Mobile Home? Yes /Lo'.
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 i
Main Floor Heated 65 i 4 i �. $ EH Bld App Review:
2T'd Floor Heated Consistency Review: 133
Other Heated <0(9 t(Z Base fee: S
p►�;t c: goo 9CiQ•rI`
Mezzanine Additional Section: ---
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee:
Unheated �� , .--
Other t G�j(p.�� Pot Water Review fee: 010 CO
Garage/Carport SUBTOTAL �ll
I Lp i7.a4
Decks 911/Rd Approach fee: 00
\--en Jclte, Pr.1 Ii�.
Other s Q�l c� 1 TOTAL: $ t'7( C , 4
Receipt Number: aD U LO I
Cash/Check Number: 121
ESTIMATED COST(REQUIRED) 7 } `0� Date:
•Fair market value of all labor and materials found is [ 1510(a
Initials:
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc
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