HomeMy WebLinkAboutBLD2007-00051 GILDING PERMIT APPLICAT ON ML v
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Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD07-00051 Received Date: 2/12/2007
SITE ADDRESS: 174 BECKER ST
PORT TOWNSEND, 98368
OWNER: JEANNINE DE BRAY PHONE: (360) 531-3046
EDWARD B DE BRAY
839 WATER ST
PORT TOWNSEND WA 98368-573C OCEAN GROVE ESTATES #2
SUBDIVISION: Block: 7 Lot: 16
PARCEL NUMBER: 977100722 Section: 24 Township: 30 N Range: 02 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: RICHARD HINER ARCHITECTS PHONE: (206) 783-8222
5337 BALLARD AVE NW (206) 783-7562
SEATTLE WA 98107
PROJECT DESCRIPTIOIF ADDITION OF MUDROOM TO EXISTING RESIDENCE
UNHEATED AND NO PLUMBING
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP ADD MAIN:
VALUATION 9,000.00 ADD'L: HEAT TYPE: UH
CODE EDITION: 2003
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: # OF STORIES:
CONST TYPE: OTHER: 120 SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM: PUD
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 0 Prop: 0
Total: 0 Total: 0
Routing Date:
11 ) f -'
Type Amount Paid Bv: Date: Receipt: Approved/Date
Permit $167.25 KAS 02/12/07 87275
Plan Check $108.72 KAS 02/12/07 87275
State Building Code $4.50 KAS 02/12/07 87275
Total: $280.47
To whom it may concern, 3/23/07
Please cancel our building permit #bld-07-00051 for a
mudroom on our house at 174 Becker St, Port Townsend.
Please remit any refund to Jeannine DeBray at 839 Water
St. PT. Thank you.
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,� JEFFERSON COUNTY '
DEPARTMENT OF COMMUNITY DEVELOPMENT� F�.� d w �.,,w7
621 Sheridan Street• Port Townsend ' Washington 98368
360/379-4450 • 360/379-4451 Fax
.../, JD www.co.jefferson.wa.us/commdevelopment J 1fAUNI I OC!I
Master Permit Application MLA: (" _ IrP
Project Description(include separate sheets as necessary):
Tax Parcel Property iLtl
Number: 9%,J/OQ ` Size: C' 0
r./�4 (acres/ quarp feet?
Site Address and/or Directions to Property: • , -tZ /C V � `"--f/�,- -its-' / 4'fr "j.. 5r-�>
Property Owner(s)of Record: ;7i`-74A/4-NC C)4-4/4-7,/L) 4:;'e /,1
Telephone: i 3tx. •- S 3/- .'4 6, Fax: (36:-,0 -
3�`�� -k l'i-5., email:
Mailing Address: • %'i tv YZ Sr./ PcILIT TzWn110,t1J
Applicant/Agent(if different from owner): E';ctt&-nW) �rsc t f+, c ttit CTS
Telephone: i 1A- 0 Jt 5 g 22
Fax: (Zv6) Jei- 75C>1' email:
Mailing Address: '35 2' .L'�-te,4"/ ,4t. n,',✓ .52) TZz: Pi/4 53/O.7)
What kind of Permit?(Check each box that applies)
,Building 0 Variance(Minor,Major or Reasonable Economic Use)
❑ Demolition Permit CI Conditional Use[C(a),C(d),or CJ**
❑Single Family ❑Discretionary"D"or Unnamed Use Classification
❑Garage Attached/Detached El Special Use(Essential Public Facilities)**
❑ Manufactured Home ❑Boundary Line Adjustment
❑ Modular Cl Short Plat**
❑ Commercial* El Binding Site Plan**
0 Change of Use Cl Long Plat**
❑ Address 0 Road Approach Cl Planned Rural Residential Development(PRRD)/Amendments**
❑Propane 0 Plat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions**
❑Stormwater Management ❑Shoreline Management Substantial Development**
❑Site Plan Approval Advance Determination(SPAAD)* C Shoreline Management Variance
❑Temporary Use C 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 ❑Tree Vegetaion Request
*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:
VcZt/�,� , DESIGNATION OF AGENT
I hereby designate j ,c e) to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE ,� -• Date: '7 / ' Z_
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. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the application thathe or she,wants prior notice.
Signature: —�-�t Date: //2 ,/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
andg non-transfer ble re pgns bility fgc dhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Si nature: _� Date: 2//,2/G 72--
C\Documents and Settings\carat\rural Settings\Temporary Internet Files\OLK86\Master Permit Application 12-19-2006.doc
• •
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 assuming the res 'bility of the General Contractor for the proposed project.
Signature: 71� Date: `7
'/Z 4
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
( ) ( )
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: ,e/(',i/yy(7.) ///%✓J •,?://)r ri PHONE (�,"C,)77L5.; j3L LL FAX:(ic;(.-) .,,'-: s.-K L,L
MAILING ADDRESS: j S j"} 'Rag--t.�r7 , Av,_ n; . -- OVA-Le kt+A-' EMAIL Y 1,i;;ZrCt,G) ,r,-t01+�: i. ,kC.t-
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New jkt Wood Existing: ❑ Sewer
13 Addition ❑ Steel Proposed: Bank 0 Community System
❑ Alteration/Remodel ❑ Concrete Total: 0 Hei ht: ❑ Individual System
❑ Repair ❑ Masonry Q SEP Permit# (1G /}t{
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Party
Type of Heat: Proposed: ,,�
ti/>'r r,4 its) Total: ‹,, Ik J�'Public
Name of System: \ 1/4.'D
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 Propanc Tank and/or Appliance Installation permit,mark all items below that apply:
❑Underground Tank ❑Above ground Tank Size of Propane Tank:
❑Heat Stove ❑Cook StoVe 0 Woodstove 0 Fireplace Insert ❑Hot Water Tank ['Pellet Stove DOther
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 EH Bld App Review: //__ yy��
`067
LLBe•oo
2ftl Floor Heated y 6 el Consistency Review: C
Other Heated t ''
Base fee: t b r a5
Mezzanine _ Additional Section:
Heated Basement Plan Check fee:
Unheated Basement _ __ State Surcharge fee:
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL
.501 , LIi
Decks __ 911/Rd Approach fee:
CC fit+ ( i
Other Got!. roc icy,'" LJ y 4TOTAL: $ 0(t\1
( �q Receipt Number: g la 75
ESTIMATED„ 9SIEQUIRED) IA ILA` � l� \ tck Number: 4 i
.Fair et value of ail labo materials foundation to finish C' . /U1
6.)00 iititiais: /
C:\Documents and Settings\carat\Local Settings\Temporary tt t]ittlit t tclrPApplication 12-19-2006.doc
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