HomeMy WebLinkAboutBLD2007-00436 IRJILDING PERMIT APPLICAT1 BLD07-00436
Review
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD07-00436 Received Date: 8/7/2007
SITE ADDRESS: 120 LYLUS LN
PORT HADLOCK, 98339
OWNER: ARNOLD F DAY TRUSTEE PHONE: (360) 385-7398
ELEANOR M DAY TRUSTEE
120 LYLUS LN
PORT HADLOCK WA 98339-9423 MELWOOD TERRACE
SUBDIVISION: Block: Lot: 28+
PARCEL NUMBER: 972000030 Section: 1 Township: 29 N Range: 01 W
CONTRACTOR: CEDAR GREEN FIX-IT PHONE: (360) 379-8400
JEFF JOHNSON
PO BOX 1433
PORT HADLOCK WA 98339
Contractor's License CEDARGF960K6 Expires 6/8/2008
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION REPLACE EXISTING DECK, SAME SIZE, SAME FOOTPRINT AND
LOCATION
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP DEK MAIN:
VALUATION 8,862.00 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: CON
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total: Total:
Routing Date:
Z 11 )01
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $167.25 KAS 08/07/07 81545 APPROVED
Plan Check $108.71 KAS 08/07/07 81545
State Building Code $4.50 KAS 08/07/07 81545 AUG 12007
Total: $280.46 Jefferson County Planning
&Balding Department
I
Jefferson County Building Derision Permit Null. r: BLD07-00436
Applicant: DAY TRUSTEE
BUILDING PERMIT INSPECTION APPROVALS applicable Code: 2006 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
Setbacks
Framing i//2-4P oA
FINAL INSPECTION f�/Z�/� !4./ aTGr -6ri4'1
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
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JEFFERSON CITY e
W DEPARTMENT OF COMMUNITY DEVELOPMENT
`' '\ .. 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
�qs �pti www.co.jefferson.wa.us/commdevelopment
bilN
Master Permit Application MLA: N o MIA "E'�O I D
Project Description (include separate sheets as necessary):
REPLACE F_XIS7 DECK — SAME S-iZc-S4 C - 60 P N i 376 S& 4-i,
Tax Parcel 4, /0'000 o0 . Property ia.O.X75- Clo >c:) 5&,4T:
Number: Size: (acres/square feet)
Site Address and/or Directions to Property:
I a t.-YLuS L4Ai E RN'? i HA DI. Oc-k
Property Owner(s)of Record: A iQt'I OL D F d- Ei E.' ,"of ' 7)4/
Telephone: 3 6O- .3 a 5-73 ?8 Fax: email:
Mailing Address: ja.0 LYL, uS LANE PO,Q T i-I A DLQJK 't%II4 '?. 3 3 q
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit? (Check each box that applies
yBuilding 0 Variance (Minor, Major or Reasonable t ',❑ Demolition Permit ❑ Conditional Use[C(a), C(d),or C]** +Rnix
��� `� r� ,
❑ Single Family ElGarage Attached/Detached ❑ Discretionary"D"or Unnamed Use ClaId'n
❑ Manufactured Home 0 Modular ❑ Special Use (Essential Public Facilities)**
❑ Commercial* 0 Boundary Line Adjustment
❑ Change of Use 0 Short Plat**
❑ Address 0 Road Approach 0 Binding Site Plan**
O Home Business 0 Cottagelndustry 0 Long Plat** I, 1i 1
O Propane ❑ Planned Rural Residential Development ? IrTl17 ,
O Sign 0 Plat Vacation/Alteration
❑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)* ❑ Shoreline Management Variance
❑ Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment
El 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 ( z T to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE (/x r^ d 1 Date: 8- 7- o 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 she wants prior notice.
Signature: b i Date: 6-- U 7
The action or actions Applicant will undertake as a esult 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 adh ring to and complying with the ESA. The Applicant has read this disclaimerO and signs and dates it below.
Signature: a..A.,n,� F. Date: �/ —7 D 7
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc
BUILDER STATEMENT ID
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: alz:11.454 F D Date:
GENERAL CONTRACTOR OR MANUFACTURED I OME INSTALLER: PHONE: FAX:
;i t=ff .7okiNson; - C�0 •R C rQ v 'FIX •. ;; (340) 379. 4800 ( )
MAILING ADDRESS: f. Q..r3ox (4 33 PORT j4 4 DLOc K ' E''01}"1-'WA• Q8 3:9
CONTRACTOR'S LICENSE WAINS
NUMBER: GE To it' 4 NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX: ( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New IP Wood Existing: ❑ Sewer
❑ Addition ❑ Steel Proposed: Bank ❑ Community System
II Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System
❑ Repair ❑ Masonry ii A SEP Permit#
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Party
Type of Heat: Proposed: 0 Public
Total: _bad_ 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? Y /� �• \t:44 � � � �
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: A
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 Cp on ,
including the reserve area. iiii0‘i
AMA
Square Footage Current Proposed For Office Use Only Amount Revision
Main Floor Heated EH Bld App Review:
2"0 Floor Heated Consistency Review:
Other Heated Base fee: IV/ a S
Mezzanine Additional Section: _
Heated Basement Plan Check fee: 101.11
ri
Unheated Basement State Surcharge fee: 4. G n
Other Unheated Pot Water Review fee: --____--
Garage/Carport SUBTOTAL asoAco
Decks 9 d Approach fee:
3 (-(.. -&1.1-1oa.76 37� a, ti44.5,1tAl
Other TOTAL: $ a 80 .4(o
Receipt Number: 915L5
Cash/Check Number:
ESTIMATED COST(REQUIRED) Date: Q 1-?1,11I Qi
•Fai market value of all labor and materials foundation to finish O
.Le 56 O Initials:
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc