HomeMy WebLinkAboutBLD2007-00459 0 MLA07-00477
.ILDING PERMIT APPLICATION ReviewType: l
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD07-00459 Received Date: 8/16/2007
SITE ADDRESS: 783 RHODODENDRON DR
QUILCENE, 98376
OWNER: JOHN N KAPP PHONE: (360) 316-1068 (CELI
MARY J KAPP THIS# FIRST)
783 RHODODENDRON DR
QUILCENE WA 98376-8602 MACDONALD SHORT PLAT
SUBDIVISION: Block: Lot: 1+
PARCEL NUMBER: 701344050 Section: 34 Township: 27 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
L- eA,r-F iL L C h cm c ICI- Lot h f-d
PROJECT DESCRIPTIOP REMODEL LOFT-ABOVE GAR , ADDTBEDROOMS
AND-ADD-STORAGE BELOW EVI St al c. .t I -1 t gJ Lc%?'t . AN-1
TYPE OF WORK GAR SQUARE FOOTAGE: 1-4� Dc-kCc.-ppc�y� r60�t A
TYPE OF IMP ADD GfAe nC l DLO
VALUATION 25,000.00 MAIN: 0
ADD'L: 0 HEAT TYPE: EEE
CODE EDITION: 2006 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: # OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: SHORELINE:
CONST TYPE: GARAGE: 264 SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: PUBLIC
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 1
Prop: 2" Prop: 0
Total: 2 Total: 1
Routing Date: i I 1 6 q ,--;:___ _
Type Amount Paid Bv: Date: Receipt: Approved/Date
Permit $391.25 KAS 08/16/07 93115
State Building Code $4.50 KAS 08/16/07 93115
Plan Check $254.52 KAS 08/16/07 93115
Total: $650.27
(4---e°14 co JEFFERSONOUNTY 4110 RECEIVE 1)
briA DEPARTMENT OF COMMUNITY DEVELOPMENT AUG 1 �, 2007 621 Sheridan Street • Port Townsend • Washington 98368
360/379-4450 • 360/379-4451 Fax
� y qsp www.co.jefferson.wa.us/commdevelopment JE [ p Q
IIING fnUNouN ace
Master Permit Application MLA: Oil - q 7 '7 •
ProjeA Description (incl separat/e sheets as necessary): a
ar
- 474-1-j-e--' i
Tax Parcel Property
Property // ' / yj
Number: 7o I 3 -/ 0 Sc Size: 40 i `� Zc' k/ (acres/square feet)
Site Addressand/or and/or Directions to Property:
`fp j
l 0 3 Jul 0/J b oLiu Jed o-N) U'L. 0� I c it_CePie ] IVA 4'3'37 �
Property Owner(s)of Recprd: ce,E3 1tJ u ,T /(,y�'i"
Telephone: 3('D 14 S yt t Fax: email: ,r(9 -, ��.N
Mailing Address: S 6-s,,...__ w¢.._ tea)--L- - _
Applicant/Agent(if different from owner): l r� l�'�� � �1 �, G' f;4 i
Telephone: Fax: a ail:
Mailing Address:
Wh t kind of Permit?(Check each box that applies
What
0 Variance(Minor, Major or Reasonable Economic Use)
O Demolition Permit 0 Conditional Use[C(a), C(d),or Cl**
faSingle Family aaCrage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification
❑ Manufactured Home 0 Modular 0 Special Use(Essential Public Facilities)**
❑ Commercial* 0 Boundary Line Adjustment
O Change of Use ❑ Short Plat**
❑ Address 0 Road Approach 0 Binding Site Plan**
0 Home Business 0 Cottagelndustry 0 Long Plat**
0 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 ❑ Shoreline Management Substantial Development**
❑ Site Plan Approval Advance Determination (SPAAD)* ❑ Shoreline Management Variance
❑ Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment
0 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 en ry to Jefferson County and its employees,representatives or agents for the sole purpose of application
review and any requir later inspections. St s access and right of entry will be assumed unless the applicant in rms the County in writing at the
time of the applicati at he e wa.psr notice.
Signature: ',.._ r A Date: 7 Z3 v 7
The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact J pon on 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 i sued will not violate the E . Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your
action(s)even if fsoll are in compliance w'th a Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transferable rrespon ability for mg to and complying with the ESA. The Applicant has read this disci i4'ner an signs and dates it below.
Signature: � s 1ti ) = ..611)-�ti-�� Date: " > ' v
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