HomeMy WebLinkAboutBLD2006-00696 QUILDING Reviewview PERMIT APPLICAAN M Review
Type:I
Jefferson County Department of Community Development
621 Sheridan Street Fort Townsend, WA 98368
PERMIT #: BLD06-00696 Received Date: 12/11/2006
SITE ADDRESS: 11 FOSTER ST
PORT HADLOCK, 98339
OWNER: GORDON A MAITLAND PHONE: (360) 301-2382
PO BOX 442
PORT HADLOCK WA 98339-0442
CHALMER'S 1ST ADDITION
SUBDIVISION: Block: 5 Lot: 25-28
PARCEL NUMBER: 942600504 Section: 3 Township: 29 N Range: 01 W
CONTRACTOR: TOWN & COUNTRY POST & FRAME PHONE: 425-743-1555
16521 HWY 99
SUITE C
LYNNWOOD WA 98037-3161
Contractor's License TOWNCPF099LT Expires 6/30/2007
REPRESENTATIVE: TOWN & COUNTRY POST FRAME PHONE: (425) 743-1555
TAMARA
16521 HWY 99 STE$...
PROJECT DESCRIPTIOI NEW POLE BUILDING
UNHEATED AND NO PLUMI3ING
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP NEW
VALUATION 15,000.00 MAIN:
CODE EDITION: 2003 ADD'L: HEAT TYPE: UH
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: # OF STORIES:
CONST TYPE: OTHER:
GARAGE: 640 SHORELINE:
CONST TYPE: SETBACK:
DECK:
BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: PUD
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 0 Prop: 0
Total: 0 Total: 0
Routing Date:
Type Amount Paid Bv: Date: Receipt: Approved/Date
Permit $251.25 KAS 12/11/06 86929
Plan Check $163.38 KAS 12/11/06 86929
State Building Code $4.50 KAS 12/11/06 86929
Total: $419.13
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d JEFFERS11000UNTY '
rouDEPARTMENT OF COMMUNITY DEVELOPMENT rif
` ki4t,
` 621 Sheridan Street• Port Townsend •Washington 98368 fl E C 1 1 2t6 6
360/379-4450 • 360/379-4451 Fax
.qN www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: Q(— (( '5
Project Description(include separate sheets as necessary): •
4'O
Tax Parcel L/2 C,0 5 Property
Number: Size: 2,3 (acres/square feet)
Site Address and/or Directions to Pro erty: // f�5 7r es 2 S — /i'va /A4,7/6; /<
Property Ow, er(s)of Record: c-,red/ /4cr
Telephone: (3i-,c) J n % `.2 ' , Fax: email:
Mailing Address: // .4' S r j2,,,, / AVC<<i<. `41'y.t3_5
Applicant/Agent(if cliff(
Town&Country Post Frame Building email:
Mailing Address: 16521 Highway 99 Ste C
Lynnwood, WA 98037
What kind of Permit?(I 425-742-1691 Fax 425-743-1555 ext. 240
Building Lic#TOWNCPF099LT iance(Minor,Major or Reasonable Economic Use)
❑ Demolition Permit u conditional Use[C(a),C(d),or C]
2 Single Family = Discretionary"D"or Unnamed Use Classification
Garage Attach /Detached ❑ Special Use(Essential Public Facilities)**
- Manufactured Hor e ~-.. . Boundary Line Adjustment
❑ Modular U Short Plat*'
❑ Commercial* 7 Binding Site Plan**
11, Change of Use ❑ Long Plat*"
❑ Address 1 Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments**
Propane ❑ Plat Vacation/Alteration**
• Allowed"Yes"Use Consistency Analysis E. Shoreline Master Program Exemption/Permit Revisions*"
Stormwater Management ❑ Shoreline Management Substantial Development**
• Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Variance
Temporary Use 7. 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 Ot -)V. 3 C)tivl /" to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE M r Date: �lz2,-4D
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 nd rig f en to this property shall be requested and shall occur only during regular business
::;ure:
Date: / 1�
The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened cr ---
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-tra arable res nsibility for adherin to an complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: Date:
C:\Documents and Settings\mochil\Desktop\Master Permit Application 7-8-04.doc
12/08/2006 11:23 4257421691 PERMABILT INDUSTRIES PAGE 04/06
OWNER 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 wilt be assuming the responsibility of the General Contractor for the proposed project,
Signature: ... " Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
MAILING ADDRESS: 'rows&Country Post.Frame Building uL:
CONTRACTOR'S LICENSE 16521 Highway 99 Ste C INS
NUMBER: Lynnwood, WA 98037 IBER
ARCHITECT/ENGINEER: 425-742-1691 Fax 425-743-1555 ext.240 NE ( ) FAX:(
lMAILING ADDRESS: Lic#TOWNCPf 099LT IL "
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
New Wood Existing: LI Sewer
❑ Addition 0 Steel Proposed: Bank
❑ Community System
❑ AlteratIon/Remodel ❑ Concrete Total: Height .111dividual System
0. Repair... n Masonry SEP #
0 Demolition th�r Bedrooms: Water Supply:
Ex1sting Setback: ❑ PrivatePermit well 0 Two
Party
Type of Hat Proposed: Public
NI'� Total: ... N' e of System:
. If this is a Comm 'al Project you must answer the following:
Number of Parking SpaC Current: Proposed: Number of ADA Parking Spaces:
Number of occupants(includes ers,tenants,employees,etc) Current Proposed
IBC Occupancy: IBC f construction: Will you have Food Service? Yes / No
If this is a Propane Tank and/or Appliance ation permit,mark all items below that apply:
I Underground Tank i Above ground Tank Size of Propane Tank:
1 Heat Stove i Cook Stove i Woodstove i Fireplace lime Hot Water Tank i Pellet Stove I Other
Is this apRllan_ce belna Installed in a Manufactured/Mobile Home s / No
'" When applying for a permit to Install a propane tank you must also subm Ile plan showing all of the buildings,all property
lines, tank location and size,distances from the propane tank to all property lr buildings and septic system components,
including theneserve area.
Square Footage 'iFCr.OfffCe.Use ,y., /�rr
Current Proposed ••«ir :vyE�t . ,c. 1 oun y.74
Main Floor r,• ,,,,
,.:.::. ConslsterityRevrew;:.........:::� - r+�a�-,:. :..
2Nij Floor w i � < .•"`1n`r. I F (, •
wy .7,i 5;::
3 V;Floor
- •.Additional Seale ,`%: . _ "M;, _W
r.,,;� .::+fir;::..,;;: -, ....,.'"�,'•i . . . `.'t.,r;;;:Cw;.
Mezzanine: GC 1 .; Plan C 2
Heated Basement W State Surcharge fee:. ry y
t „
Unheated Basement ,
i st 4,�
Pot Water Review-lee
Other Unheated - fz'- 911/Rd A e: A
;Garage/Carport � ......,..:. :. .. ,'; .. .... - .. . . ,
, .
3-7 r3 r.
Decks ;:
Other Cash/Check Number: { q
ESTIMATED COST REQUIRED j'1 1�-•_
y ku v`'ib
.Fairmarkot value of � .:f{�•,rand mate�talslau�laNe� !�,' �"^;���'' '
It7 f$, : :
(;:\I-)ncumcnt;and.1"ettin�,..t\mochil\Desktop\Maccer Permit Application 7_ H{.dnc
12/11/2006 14:46 4257421 1 PERMABILT INDUST: ES PAGE 02/02
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