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HomeMy WebLinkAboutBLD2007-00329 MLA07-00344 UILDING PERMIT APPLICAON ON Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00329 Received Date: 6/19/2007 SITE ADDRESS: 2943 BEAVER VALLEY RD PORT LUDLOW, 98365 OWNER: LAURA STORM PHONE: 360-732-481 1 2943 BEAVER VALLEY RD PORT LUDLOW WA 983659245 R. WITTER SHORT PLAT SUBDIVISION: Block: Lot: PARCEL NUMBER: 821073010 Section: 7 Township: 28 N Range: 01 E CONTRACTOR: OWNER/BUILDER PHONE: r‘ REPRESENTATIVE: PHONE: ky0c..ie/%).)-511:6 PROJECT DESCRIPTION NEW SFR - 2ND FLOOR ADU (960 SQ FT - 1 BR & 1 BTH) TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 1,920 VALUATION 278,000.00 ADD'L: 960 HEAT TYPE: EEE CODE EDITION: 2003 HEAT BASE: HEAT TYPE: OCCUPANCY: R-3 UNHEATED: # OF STORIES: OCCUPANCY: CONST TYPE: 5N OTHER: 100 SHORELINE: GARA CONST TYPE: DECKLE 290 SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: PWELL BEDROOMS: BATHROOMS: Exist: Exist: Prop: 3 Prop: 3 Total: 3 Total: 3 Routing Date: (olic\ 10 --\ Type Amount Paid Bv: Date: Receipt: Approved/Date Permit $1,996.15 CJZ 06/19/07 91187 Plan Check $1,297.50 CJZ 06/19/07 91187 State Building Code $4.50 CJZ 06/19/07 91187 Potable Water Application $58.00 CJZ 06/19/07 91187 Total: $3,356.15 • L.At)24 St of 2g43 ��E2VA Lt. �y RECEIVED pr ��0 L���,v wA etg365 O C T 1 1 2007 L ScALF, Dt(C-rot JEffEIR �IN COUNTY DCD 3EF��,saN C��v�y Pe-er off' COM M tJ N t ry ✓E Lo pM iti 621 5HE-2toFlA) 5r PY Tow N s EN_D QcT IC 2007 DE>42 M2 CALF T1ts suMME2 w� APPLIED Fop. A 6uic-Dl))G- P&( M rr Fog 214.3 66-Akt2 f VaLL6y AD ouR MoPE2- / a H T tS A rPLicA rtoN wAS 6tVeit) rt-{E- NoMt3E-2 5LE) d 7- 32?, ‘Jc WISH To CANCEL AND c' ITf♦D('�At,o THIS APPL(C,gT(O�11,, I U ti;p E 2 STA N() -rt-tat r-te- PO Q r(CA) o F THE-& FE-6 Re c.H-ri'v G- `o _n* VAwF of -ritf. ADD tTIOA) QEFuNDA6LE. The t6u2E DE2tv£D tN you2 oPFtcES oN ©cr 5 AMoUA P -c_cC 15 ?6 , q2 , --F-1-4Atii4._ you For-'-- rN6 -TIME AA)D 1-r E-Ar t oAJ you HAVE pLl-r NTC� -n-t (s MA-r-r6?, I 'vim • JEFFERSON CJNTY "ON c°efr� DEPARTMENT OF COMMUNITY DEVELOPMENT ti ad �C �® 621 Sheridan Street .q�, NG:( Port Townsend, WA 98368 Al Scalf, Director 2120-7 ) C16,Z) 0-7,-372t / 4' ) 1 ,) rA/Kk 4t2 virrylaw/krtz7e// ovr 77 ,fir ft A flICelq7 o 2 g41i, 1 1R WED OCT 11 2007 EFf E 9 MIMED Building Permits/ Inspections Development Review Division Long Range Planning (360) 379-4450 FAX: (360) 379-4451 likr c0�,, JEFFERS+COUNTY W 1q 4-`,3 DEPARTMENT OF COMMUNITY DEVELOPMENT ~' v "4 621 Sheridan Street • Port Townsend •Washington 98368 4gypr.' 360/379-4450 • 360/379-4451 Fax ryys,ii*INGp� www.co.jefferson.wa.us/colnmdeveloprnent l JUN 9 200 7 Master Permit Application E MLA:RI .,,0 - — 3`A`A- Project Description(include eparate sheets as necessary): 5FR A.) 2,Ad -I06,r. ADo Tax Parcel p y Number: 0 7 I Q Property - D ©ze re S (acres/square feet) Site Address and/or Directions to Property: 2/Lt 3 FrH✓ER. VAi.i.c.y(2D Pt- Luo LG+4.' CVA `f 'j6" 5 Property Owner(s)of Record: 1.-.A u&A B -< -�o ri{) f. H. ST-or:NI Telephone: 360 -7 3 7 it b i t Fax: email: ..-f3SrO1 M t --Sc N E T coM Mailing Address: See o;loo,;e Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies) Building 1 Variance(Minor, Major or Reasonable Economic Use) I Demolition Permit Conditional Use C a , ** Single Family w�2�d c(oov-ADV I Discretionary"D[or Unnamedor Use Classification I Garage Attached/Detached I Special Use(Essential Public Facilities)** I Manufactured Home I Boundary Line Adjustment I Modular 1 Short Plat** I Commercial* I Binding Site Plan** I Change of Use I Long Plat** I Address I Road Approach I Planned Rural Residential Development(PRRD)/Amendments** I Propane 1 Plat Vacation/Alteration** I Allowed"Yes"Use Consistency Analysis 1 Shoreline Master Program Exemption/Permit Revisions** I Stormwater Management I Shoreline Management Substantial Development** I Site Plan Approval Advance Determination(SPAAD)* I Shoreline Management Variance I Temporary Use 1 Comprehensive Plan/UDC/Land Use District Map Amendment I Wireless Telecommunication* 1 Jefferson County Shoreline Master Program Amendment I 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 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 application that he r she wants / Signature: et �P rfbF JL t2--�i 2...1---, Date: Ma) I 3 ; .c 77 The action or action Applicant will undertake as a result of the issuance of this permit may negatively impact upon r5ne 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 res nsibility for a ri to d complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: Date: 4/1�t i 3 zoo? f G:\PennitCenter\FORMS\DRD FORMS\Master Permit Application 07-14-2006.doc • BUILDER STATEMENT • The signer of this st a ent does reby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will b su inl t tresp si lity of the General Contractor for the proposed project. Signatur �'�_ Date: O 1—f�� Gl�j i GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: New X Wood Existing: LI Sewer ❑ Addition ❑ Steel Proposed: Bank u Community System ❑ Alteration/Remodel 0 Concrete Total: _i Height: '4 Individual System ❑ Repair 0 Masonry SEP Permit# S E P O. 17( ❑ Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: X Private well ❑ Two Party Type of H at: Proposed: I I Public / , v4Irfti),l Total: 3 Name of System: If this's a Commercial Protect 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: 1 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 , s - 1��► i�� &G EH Bld App Review:k. toG 2nd Floor Heated �p(I ��dK OA Consistency Review: 5 $toOlk Other Heated Base fee: t G . 11 c\2.is >t `�J V Mezzanine 3 Additional Section: _____ Heated Basement Plan Check fee: . l c° I,b ► • Unheated Basement State Surcharge fee: - 5 C) 4 Other Unheated Pot Water Review fee: �'93. II Garage/Carport SUBTOTAL 3,b la•t S aldo,., 4 c . U �, 11 ?lodcp 00 01 Decks r I ., E3 911/Rd Approach fee: x►- �`"l,•,�`� c-� ('Q1�35 I I— Other .... Vail"`— TOTAL: $ a l )s . Receipt Number: Gi I 1 V 11 j Cash/Check Number: _ ---1 a4q(0 ia31 ESTIMAIED-CAS-TWQUIRED) . Dater (�;� '� I t�� •Fair market value of all labo nd materials foundation to finish i 411, Y --if, 3 0 y Initials: ,�/ �NTY G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 07-14-2006.doc D B/E LO P t.1 E N T 1 4 .ww......e......am.wa. a''....�._..,awa.MI :��?■ w _..ram I II aa!<re i'i Ipm H b a E' .� Ii' i II 1. t s'" M li s°`.. 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