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Home My WebLink AboutBLD2007-00249 -.ILDING PERMIT APPLICATOJ B RD07-00249 Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00249 Received Date: 5/22/2007 SITE ADDRESS: 51 MARINER PL PORT LUDLOW, 98365 OWNER: THOMAS E LOHREY JR PHONE: 360-437-7760 PATRICIA A LOHREY 51 MARINER PL PORT LUDLOW WA 983659765 BAYVIEW VILLAGE DIV 2 SUBDIVISION: Block: Lot: PARCEL NUMBER: 931900015 Section: 16 Township: 28 N Range: 01 E CONTRACTOR: PARKER ENTERPRISES PHONE: 360-437-0612 70 MERRIDITH ST PORT LUDLOW WA 98365 Contractor's License PARKEE*045K9 Expires 1/2/2008 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP REPLACE EXISTING ROOF -NO MLA REQ'D TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP REP MAIN: 'VALUATION 2,000.00 ADD'L: HEAT TYPE: CODE EDITION: 2003 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid Bv: Date: Receipt: Approved/Date Permit $69.25 LYK 05/22/07 91072 Plan Check $45.01 LYK 05/22/07 91072 State Building Code $4.50 LYK 05/22/07 91072 Total: $118.76 Jefferson County Building Diveon Permit Numb Applicant: BUILDING PERMIT INSPECTION APPROVALS kpplicable Code: International Building Codes To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection. Requests received after 7:00 AM will not be scheduled for that day's inspections. ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries. The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection Inspection Item Date Approval Signature Notes FINAL INSPECTION 9//6/Ds Oe Cr- ft-x.-' FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR IR ‘- f w4' oJEFFERSUN' gq � DEPARTMENT OF COMMUNITYP {�.t�lep `� b `4 621 Sheridan Street • Port Town d srz li 1 360/379-4450 360/379-4451 Fax k" p$ www.co.jefferson.wa.us/commdevelopment �s�zNGz MAY 2 2 2Q: Master Permit Application MLA: NO mL� n Project Description(include separate sheets as necessary): a, I i= `AM liE ep/ae-J;l.� shake �f wit OS vaderla ymeu a ratvhrkos//raw Siortyks- Tax Parcel Gppgi �� DI6 Property Number: r Size: (aefee/square feet) Site Address and/or Directions to Property: 67 /yar/I/CT- %/C e , /or/ ii //) l t1i1 €5736 t-C-- Property Owner(s)of Record: 77td7rfa 5 E, afr-ic/fit W• Loffret/ Telephone: (36o) 43 7— 7 76d Fax: email:79/7f/okret/pAgesteai.eo- Mailing Address: 5//v/&/rrer i4(ace, Aft Lu ai.rJ,AO 1S-36.s— Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies ❑Building 0 Variance(Minor, Major or Reasonable Economic Use) LIJ Demolition Permit ❑ Conditional Use[C(a),C(d),or C]** reif Single Family 0 Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home ❑ Modular ❑ Special Use(Essential Public Facilities)** ❑ Commercial* 0 OE Rex*" ❑ Boundary Line Adjustment ❑ Change of Use 0 Short Plat** ❑ Address 0 Road Approach 0 Binding Site Plan** ❑ Home Business 0 Cottagelndustry 0 Long Plat** ❑ Propane 0 Planned Rural Residential Development(PRRD)/Amendments** ❑ Sign 0 Plat Vacation/Alteration** 0 Allowed"Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions** ❑Stormwater Management 0 Shoreline Management Substantial Development** ❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Variance 0 Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* 0 Jefferson County Shoreline Master Program Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium 0 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: 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. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the ap lic on that hes she w is prior notice. _ )0 ? Signature: Date: 3 The action or actions Applicant will underta 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-transfer le responsibjl- for adh 'ng to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: yeefie *4-rl Date: S1L-Vo 7 6 • DUILUtrc J IA ItIVIePI I • 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 responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: P,42ie6,e Gvc-epeiszS (360 )437-D6/ ( ) MAILING ADDRESS: 70 M rD J/ L(io mow' W61 EMAIL: CONTRACTORS LICENSE I WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: LI New ❑ Wood Existing: ❑ Sewer ❑ Addition 0 Steel Proposed: Bank ❑ Community System O Alteration/Remodel 0 Concrete Total: Height: LI Individual System ❑ Repair ❑ Masonry SEP Permit# O Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: LI Private well LI Two Party Type of Heat: Proposed: ❑ Public 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, f lnpemplgyees,etc�Current Proposed IBC Occupancy: IBC Ty. construction: �\�! ' i Will you have Food Service? Yes / No If this is a Propane Tank and/or Appliance Installation permit, all items below that apply: i Underground Tank i Above ground Tank Size of Propane Tank: i Heat Stove i Cook Stove i Woodstove i Fireplace Insert i Hot Water Tank I Pellet Stove i Other 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�i tl/property lines,buildings and septic system components, including the reserve area. 'I Square Footage Current Proposed For Office Use Only Amount Revision Main Floor Heated EH Bld App Review: 2"tl Floor Heated Consistency Review: Other Heated Base fee: aj Mezzanine Additional Section: l._�p_I Heated Basement Plan Check fee: p Unheated Basement State Surcharge fee: 59 fJ� Other Unheated Pot Water Review fee: -__ Garage/Carport SUBTOTAL I q' ritP Decks 911/Rd Approach fee: ___-- --- Other TOTAL: $ 1 ` S r(Q Receipt Number: I I O1Q Cash/Check Number: c9C '7 ESTIMATED COST(REQUIRED) Dale: .Fair market value of all labor and materials foundation to finish as Or] 0 Z. Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc