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Home My WebLink AboutBLD2007-00268 JILDING PERMIT APPLICAT*V BLD07-00268 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00268 Received Date: 5/29/2007 SITE ADDRESS: 41 MARINER PL PORT LUDLOW, 98365 OWNER: ANNELIESE F LARKIN PHONE: 360-437-2600 41 MARINER PL PORT LUDLOW WA 983659765 BAYVIEW VILLAGE DIV 2 SUBDIVISION: Block: Lot: 16 PARCEL NUMBER: 931900016 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 DESCRIPTIOr 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 By: Date: Receipt: Approved/Date Permit $69.25 LYK 05/29/07 91086 Plan Check $45.01 LYK 05/29/07 91086 State Building Code $4.50 LYK 05/29/07 91086 Total: $118.76 Permit Num. Jefferson County Building Dillon Applicant: BUILDING PERMIT INSPECTION APPROVALS \pplicable Code: International Building Codes To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection. Requests received after 7:00 AM will not be scheduled for that day's inspections. ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries. The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection Inspection Item Date Approval Signature Notes FINAL INSPECTION FINAL INSPECTION MUST BE PERM TO ISVDLID FOR O O BUILDING BEING OCCUPIED k��goN CO&� JEFFERSON•UNTY • g� DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend • Washington 98368'..i 360/379-4450 • 360/379-4451 Fax ; 11,9, ( .0 www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: 1\_)O V ( A ►ti� Project Description(include separate sheets a necessary): � 1-- Lim-- v) � i�l72CCG/=' Tax Parcel tli-. Property Number: Size: (acres/square feet) Site Address and/or Directions to Property: L// /444g1 i l'L PC_46E, pe n r 04_a w w A ?A3 6.5 Property Owner(s)of Record: A N N E.L JE$,r 4 4a Ki 1.1 Telephoner y5T/ 2 4CX_) Fax: email: Mailing Addres : 5 11ti6_. Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit? (Check each box that applies ❑Building ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit ❑ Conditional Use[C(a),C(d),or C]** ❑ Single Family ❑ Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home 0 Modular 0 Special Use(Essential Public Facilities)** ❑ Commercial* 04 i.V Z o o F. ❑ Boundary Line Adjustment ❑ Change of Use 0 Short Plat** ❑ Address 0 Road Approach ❑ Binding Site Plan** ❑ Home Business ❑ Cottagelndustry 0 Long Plat** ❑ Propane ❑ Planned Rural Residential Development(PRRD)/Amendments** 0 Sign ❑ Plat Vacation/Alteration** ❑Allowed"Yes" Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions** ❑ Stormwater Management 0 Shoreline Management Substantial Development** ❑ Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Variance ❑ 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 ❑ Tree Vegetaion Request *May require a Pre-Application C ference **Requires a Pre-Application Conference Please identify any other local, s ate 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 L/(11 77/41 Date: 7 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 that he or she wants prior notice. Signature: Date: 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 responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: , [ Date: lie— tOkin LIL) C� t — '(� IL c.S . G:\PermitCenter\###FO S###\DRD FORMS\Master Permit plication 2-19-2006.doc • BUILDER STATEMENT -1. • The signer of this statement d '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 r s ibility of the General Contractor for the proposed project. � Signature: Date: 5 G 7/, 67 GE ERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: 266) gM // ( AILING ADDRESS: 7b Ji/C.it��`''i74 5 4�r EMAIL: CONTRACTOR'S LICENSE! i"'" LVyJLe_., WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ 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,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: 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 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: 2nd Floor Heated Consistency Review: Other Heated Base fee: (0 l Mezzanine Additional Section: -,------ Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Ai G.) Other Unheated Pot Water Review fee: _----- Garage/Carport SUBTOTAL I I Q 1 _ Decks 911/Rd Approach fee: p--- (o- Other TOTAL: $ l is ....7(10 Receipt Number: Q I/ti)I C, Cash/Check Number: (5 ESTIMATED C•=i REQUIRED) Date: .J •Fair market veto:Zvi labor and materiVoundation to finish 0-1 —�/ w G Initials: (- 51, G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc