HomeMy WebLinkAboutBLD2006-00648 06
•UILDING PERMIT APPLICATT'i)N MRL Review Ty
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ype
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD06-00648 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 DESCRIPTION NEW DETACHED GARAGE/SHOP - UNHTD, NO PLMB
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP NEW
VALUATION MAIN:
CODE EDITION: 2003 ADD'L: HEAT TYPE: UH
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: # OF STORIES:
CONST TYPE: OTHER: SHORELINE:
CONST TYPE: GARAGE: 528 SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 0 Prop: 0
Total: 0 Total: 0
Routing Date.
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $251.25 LYK 11/15/06 86862
Plan Check $163.31 LYK 11/15/06 86862
State Building Code $4.50 LYK 11/15/06 86862
Total: $419.06
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,�4> �N cOr, JEFFERSAPCOUNTY . ._� .t! ,� .F ` ; ,;
1 DEPARTMENT OF COMMUNITY DEVELOPMENT
5,"
` '4 621 Sheridan Street • Port Townsend •Washington 98368 ( OW 1 5 aka
360/379-4450 • 360/379-4451 Fax
q�, N0A*0� www.co.jefferson.wa.us/commdevelopment i.
t'OlIN 5,1 i
Master Permit Application MLA: ()
Project Description(include sepalate sheets as necessarar);
»Crt,,C� Fi.> ECE ,S 1-1.i-P" L-u -�C l--)
Property
Tax Parcel Number: 1 (s2 I [ I Lip t Size: o Z3c.3cre I c MS c i�, (acres/square feet)
Site Address and/or Directions to Property: Co-cruzy Let- t sI ALMA V'Lw,!kw- aA4ut W;I :s,;,,, Prei-1-c- ,,e-( t3e;
Property Owner(s)of Record: ern'/ ,r? y &k,xr-t-J
Telephone: Fax: email: .
Mailing Address:
Applicant/Agent(if different from owner): At-it, i c�t GtK-.Sscri..i
Telephone:. ,..3eS 4L,Zv Fax: a, email:
Mailing Address: 21Z— /Y1A-Kter Lavr=i -titer'rewti`;-�.ko.j WA- gt-i3i F
What kind of Permit?(Check each box that applies)
)(Building C]Variance(Minor,Major or Reasonable Economic Use)
❑ Demolition Permit C] Conditional Use[C(a),C(d),or CI**
d,Single Family Cl Discretionary"D"or Unnamed Use Classification
XGarage Attache /Detached ❑ Special Use(Essential Public Facilities)**
❑ Manufactured Home Cl Boundary Line Adjustment
❑ Modular Cl Short Plat'"`
❑ Commercial* Cl Binding Site Plan**
❑ Change of Use Cl Long Plat**
> Address 0 Road Approach CI Planned Rural Residential Development(PRRD)/Amendments**
(Propane Cl Plat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions**
❑ Stormwater Management CI 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 40 n` J-i( y-U
_ � to act as my agent in_matters relating to this application for permit(s).
OWNER SIGNATURE j Date: ////'//U(o
By signing this application form,the owner/agent attests that the inf ation 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.
Signature: i_..., ,
� 4,f .�� .E:�y Date: ll /��OCo 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 lake"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 ibility for erig o an omplying with the ES ,The Ap 'lica as read this disclaimer and signs and dates it below.
Signature: Date: ////q/ U 0
/
6
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Atmlieli em I2An_nS,4,-,e
I • •
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 assu ir the responsibility of the eneral ntractorfor the oposed project.
Signature: C. a-C A/ e-it/ 07 ' Date: ////'9/C6
GENERAL CONTRACTOR OR MANUFACTURED HO INSTALLER: PHONE: FAX:
( ) ( )
MAILING ADDRESS: f, 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: _- - 0 Sewer
0 Addition 0 Steel Proposed: Bank Height: ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: q Individual System
❑ Repair ❑ Masonry SEP Permit# cvk.)- CU t 9t
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: ,__t__ Setback: ❑ Private well ❑ Two Party
Type of Heat: Proposed: g.Public
v/v i4E2trelJ Total: Name of System: f7t'D ice,
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 X Above ground Tank Size of Propane Tank:__
_ Heat Stove X Cook Stove ❑ Woodstove 0 Fireplace Insert ❑ Hot Water Tank 0 Pellet Stove ❑ Other
Is this appliance being installed in a Manufactured/Mobile Home? Yes /t�o
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 properly lines,buildings and septic system components,
including the reserve area.
W.
Square Footage Current Proposed ,ri ce Use, �14cN ,t t __nt .. 4 evisrori�r :,
Main Floor Heated EH BId App Review:
WIFE
2nd Floor Heated Consistency Review:
(A))S F__
Other Heated Base fee:
5.l.as
Mezzanine Additional Section:
Heated Basement -- Plan Check fee:
143.31
Unheated Basement State Surcharge fee: ed .5,_
,
Other Unheated ' Pot Water Review fee: )/) r�
fi
MN 0
Garage/Carport SUBTOTAL
Decks Y y t l i h ., / ,Approac fee: S
Other L' 41 TOTAL: $ ICI. 04
S,: Receipt Number: S./ 00-
yh �✓
At.
!.w,'1 Ey `. Cash/Check Number:
ESTIMATED COST(REQUIRED) Date: d1510(p•Fair market value of all labor_and materials foundation to finish _
Initials:
G:\PermitCenter\F Master Permit Application 12-30-05.doc
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