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HomeMy WebLinkAboutBLD2007-00412 tILDING PERMIT APPLICAT!N MLA07-00428 Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00412 Received Date: 7/25/2007 SITE ADDRESS: 685 LUDLOW BAY RD PORT LUDLOW, 98365 OWNER: DWIGHT F HAUPTMAN TRUSTE PHONE: (360)437-8097 MARIANNE HAUPTMAN TRUSTEE 685 LUDLOW BAY RD PORT LUDLOW WA 98365 LUDLOW BEACH TRS 2 SUBDIVISION: Block: Lot: 6 PARCEL NUMBER: 969000006 Section: 16 Township: 28 N Range: 01 E CONTRACTOR: PACIFIC PILING & UNDERPINNING PHONE: (425) 485-8869 PO BOX 2080 WOODINVILLE WA 98072 Contractor's License PACIFPU033BH Expires 1/16/2008 REPRESENTATIVE: DENNIS TITUS PHONE: (425) 778-8500 C G ENGINEERING (425) 778-5536 250 4TH AVE S STE 200 PROJECT DESCRIPTIOr REPAIR ROCK WALL TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP REP MAIN: VALUATION 20,000.00 ADD'L: HEAT TYPE: CODE EDITION: 2006 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: ita,(401 Type Amount Paid By: Date: Receipt: Approved/Date Permit $321.25 KAS 07/25/07 91525 State Building Code $4.50 KAS 07/25/07 91525 Total: $325.75 I Tidemark Advantage _)91 xj F'e Edit Options Wirnlrw Help Exit New Open Ta.k list GIBE GIS !f 1 i23 + C23 `®..... IQ P1 a Close Edit Renumber Cases New Ca:c People Address Tag: Covenants Ooeuments Print GIS "'WARNING:PARCEL TAGS)ATTACHED"' Parcel I PIFI flC WITII RAI fa I ARf1 C AD.GDAAA AC..IAD .,.I AMi..o Sut Associated Cases �.a r ,� • 'a ? ' Xf Parcel# Case# Address 969000006 BLD01-00025 685 LUDLGItV BAY RD Select 969000006 BLD02-00404 685 LUDLOW BAY RD 969000006 BLD03-00027 685 LUDLOW BAY RD — 969000006 BLD06-00481 685 LUDLOW BAY RD 969000006 BLD07-00412 685 LUDLOVY BAY RD Schoo 969000006 PRE02-00044 685 LUDLOW BAY RD Plan' 969000006 PRE07-00048 685 LUDLOW BAY RD Help 969000006 SDP07-00060 685 LUDLOW BAY RD 969000006 SEP01-00095 685 LUDLOVV BAY RD Done 969000006 SEP85-00135 685 LUDLOW BAY RD Cen 969000006 ZONO3-00007 683 LUDLOW BAY RD Leg [UN.. {.._. _... ._..J '.i _I Cases associated with this parcel tf StartI Lit] jTi+ ]Inbox-Microsoft...I ■Tidemark Adva... default.rsf-Refle,..I J Documents-Micr.,. ra a 8:21 AM v RI2C—m T COJv (-9 Q Clt4¼O (\a\ (AS (:)c)1Q..„ ;10 raLA6-1 --(QfR 1)802) et ld (tY-ts I tel C)/ 1C S- kVO. ‘--40 C pccs:3-cc • r i , ' rf `i c '04 (".,,,-.:s0N—oc* �� JEFFERSOI�UNTY rt •- ' DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax .gsti-INIp� www.co.jefferson.wa.us/commdevelopmentf iiiiiirp Master Permit Application MLA: C.r1 I- 2P Project Description(include separate sheets as necessary): . d le,t>J .gQa .i TeC 7. t`-;� .,& �z�<i�� r' Rik C..)411 Tax Parcel r� Property Number: '1 L OOOOOG. Size: (acres/square feet) Site Address and/or Directions to Property: c Luel IQ u° l'� y� ey gel I Ot ( i.z A lcTtJ/(. Property Owner(s)of Record: j7Lj rjt4-t. Ha�r>kr- m Telephone: AO- cf3-- Q7 Fax: email: Mailing Address:6SS- (z,el 4,,,,.) t� J-ei Li 1�-J / OA Applicant/Agent(if different from owner E>,:,,I 6,5 -/ ,_,,c Telephone: `.j75- 71'4,,*; -'SUc; Fax: `f'zS-7.. <- 3C� email:N4ri, T6, CG-(��a4-t..;Hee;;.,-. Mailing Address: "'S?� <-i t', ,1 _` t y �`� /�+,-x� � ..�t.„r}�C� ca., �'71L'Y(df'. � )�f W at kind of Permit? (Check each box that applies Building ❑Variance(Minor, Major or Reasonable Economic Use) Demolition Permit 0 Conditional Use[C(a), C(d),or C]** ❑Single Family 0 Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home 0 Modular ❑ Special Use(Essential Public Facilities)** ❑ Commercial* 0 Boundary Line Adjustment ❑ Change of Use ❑ 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** ❑Allowed"Yes" Use Consistency Analysis XI,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 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 " ' t' 421-‘- to act as my agent in matters relating to this pplication for permit(s). OWNER SIGNATURE ' � Date: 7,23 Oi By signing this application fo the owner/agen ttests 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 a d right of entry will be assumed unless the applicant informs the County in writing at the time of the a^^"cation that he or she wa rio-noti . Signature: \ • G Date: V2 5/b4- The action or actions Applicant will underta as a result of thissuance 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 issue 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 r in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-trans abl po ibi f r adhering� to and complying with the ESA. The Applicant has read this disclai er a d signs and dates it below. Signature: 4 Date: 7ei 7 G:\PermitCenter\###FORMS###\DRD FORMS\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 responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: - ri +i/ /11nG U/�ICter lrlprn (yzc ) (tic- '�tb ( ) MAILING ADDRESS: ,J Tp g 'j O �,,�,N�t/le. y86F ra EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: Dt 'IFIX'to 35 g H NUMBER ARCHITECT/ENGINEER: C.& -Ni, PHONE ( ) FAX: ( ) MAILING ADDRESS: L 4) Lish 4i.C%S S.454.0 zoo .-t...u:1dS (oil EMAIL Project Type: Frame Type: Bathrooms: eff,a0 Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System y Repair ❑ Masonry SEP Permit# Water Supply: ❑ Demolition ❑ Other: Bedrooms: pp y: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: ❑ Public Total: Name of System: If this is 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: i Heat Stove i Cook Stove i Woodstove i Fireplace insert I Hot Water Tank i Pellet Stove 1 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. h Square Footage Current Proposed 'For-,,Office Use06:ti ,..6.z.k : _ . 6 - mount :`. , Revision F_, Main Floor Heated EH Bld App Review: Na Eta 1-Y— 2nd Floor Heated Consistency Review: /807,T;`3)\?-P T Other Heated `. Base fee: 3 t 1 oCZ 1"1 .:� Mezzanine R ���4 1314 ,Ai:''_ ' - 1\0 1 Ink 1C14R. -f,-1 OD Heated Basement ` Plan Check fee: NV N k- Unheated Basement t State Surcharge fee: �^ Jo MINDOther Unheated t ,� 1\'\;ilia€ Pot Water Review fee: ____t uu Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: 4 list t ,c Other , i RewAl) TOTAL: $ L,-2 J 11 Receipt Number: Cf 15a5 Cash/Check Number: �j lc ` ' 5- ESTIMATED_CQSI(REQUIRED) Date: /a.5/ ,7 •Fa'crri9 t value of all labor a materials foundation to finish 76)0b0 Initials: 0 - G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc Z —1 n . , - _o oic3) 73 i CI) 0 c° )--; '- ''-, : C t„,, 1,; .. 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