HomeMy WebLinkAboutBLD2007-00571 IU ILDING PERMIT APPLICA*N ML 607
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Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD07-00571 Received Date: 11/6/2007
SITE ADDRESS: AIRPORT CUTOFF RD
OWNER: WILLIAM D LEAVITT PHONE: 360-507-7200
PO BOX 1234
PORT HADLOCK WA 983391234
SETON SHORT PLAT
SUBDIVISION: Block: Lot: 4
PARCEL NUMBER: 001282025 Section: 28 Township: 30 N Range: 01 W
CONTRACTOR: SECRET GARDENS BY SHEILA INC PHONE: 360-301-2643
177 POTLATCH WAY
PORT TOWNSEND WA 98368
Contractor's License SECREGS93001 Expires 9/21/2009
REPRESENTATIVE: SHEILA PICCINI PHONE: 360-301-2643
177 POTLATCH WAY
PORT TOWNSEND WA 98368
PROJECT DESCRIPTIOP NEW 8' FENCE
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION 3,000.00 ADD'L: HEAT TYPE:
CODE EDITION: 2006
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
CONST TYPE: OTHER: 300 SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total: Total: _ _�
��Routing Date:
(r) .—1
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $83.25 LYK 11/06/07 95379 APPROVED
Plan Check $54.11 LYK 11/06/07 95379
State Building Code $4.50 LYK 11/06/07 95379 NOV.21 2007
Total: $141.86
Jefferson County Planning
&Building Department
Jefferson County Building Dijon Permit Nun.: BLD07-00571
Applicant: LEAVITT
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
Post Holes
Framing ( - 2S U A
v
FINAL INSPECTION -
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
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4SON c JEFFERS*OUNTY {
DEPARTMENT OF COMMUNITY DE 'L P EN1'. '. \ _'. ''v -4 621 Sheridan Street • Port Townsend • Washington 98368
360/379-4450 • 360/379-4451 Fax
�qs 0� www.cojefferson.wa.us/commdevelopmeNOV 0 6 :2001 •
Master Permit Application tc ;r r'f q,1 f ig' M 1
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t . sir.,
Project Description (include separate sheets as necessary):
Fen.C 43' w h _
Tax Parcel �, I ,� �, Property G ,,,
Number: U/ � LJ✓1.. Size: A a / t<, (acres/square feet)
Site Address and/or Directions to Property:
/ 5 34,1. Pr(r- - C04-or-F r . Parr 7 t,JA, call LU -i q83CoeP
Property Owner(s)of Record: (t' /yi'"of R. G g vii7
Telephone: .3(.-'cc 54.'7 - 7.2ct1 Fax:.3(>c,> -3r1-5 V 7e):.)--
email:
Mailing Address: R. C. -''- i Z 3`I ?0,-, J-a,'c1I0 tk (./ 2.: 9,')3 `j
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applias
❑Building ❑Variance(Minor, Major or Reasonable Economic Use)
❑ Demolition Permit 0 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* tg PENC-E ❑ Boundary Line Adjustment
0 Change of Use 0 Short Plat**
❑ Address ❑ Road Approach ❑P• ,ding Site Plan**
❑ Home Business 0 Cottagelndustry ❑ ._ong Plat**
0 Propane ❑ Planned Rural Residential Development(PRRD)/Amendments**
❑ Sign ❑ Plat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis ❑ 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
❑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 �-(Ga L A pt%.ct t-r( j.-�, to act a�yant in matters relating to this application for permit(s).
OWNER SIGNATURE %. � �� �'-' e_I— a / -/ — c
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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 rig t of ent I be.a med unless the applicant informs the County in writing at the
time of the applica ion t e or s/ h�vrapts ,,Rotice. _ �/�
Signature: /: <r% •�'/ 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 ja compliance with the Jefferson County develop ent code. e Applicant acknowledges that he,she or it holds individual
and non-transfyably,r6ponsibitiadhering to and co ying • e licant has read this disclaimer and signs and dates it below.
Signature: e::‘..-."-- % / Date: // — f-- j'
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc
• BUILDER STATEMENT li
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:
5ec -& 6a-r3-a-ru- lot 5hAtiA J 1rnc. (360o ) 3J/ 2(e:Iy3 (360) 3-7R 4-f7i9
MAILING ADDRESS: I T7 /, ew`/_ � EMAIL:
CONTRACTOR'S LICENSE t(w[� WAINS
NUMBER: SGi c_ 6 s 9 3 oo ( NUMBER
ARCHITECT/ENGINEER: fj/A PHONE ( ) FAX: ( )
MAILING ADDRESS: ' EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
O New 0 Wood Existing: 0 Sewer
0 Addition ❑ Steel Proposed: Bank ❑ Community System
O Alteration/Remodel ❑ Concrete Tots Height: 0 Individual System
O Repair ❑ Masonry SEP Permit#
O Demolition 0 Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well 0 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:
j Underground Tank i Above ground Tank Size of Propane Tank:
I Heat Stove i Cook Stove i Woodstove 1 Fireplace Insert 1 14,),Water Tank i Pellet Stove i Other
Is this appliance beinq install d in a Manufactured/Mobile Home? Yes I 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 �� "f t rµ`
Consistency Review:
Other Heated Base fee: rxx
Mezzanine - Additional Section:
Heated Basement Plan Check fee:
.51 , tl
Unheated Basement State Surcharge fee: _T�{
-5
Other Unheated Pot Water Review fee: n
Garage/Carport SUBTOTAL q
r l
iLiis
Decks 911/Rd Approach fee:
Other Feu\c. ahtc�l I 11 1+ ny
� 300l TOTAL: $ g0
F4• Receipt Number: el'33-
Cash/Check Number:
ESTIMATED COST(REQUIRED) Date: 1
•Fair market value of all labor and materials finish �— C1
41. 3030,0 j Initials:
c
G:\PermitCentcr\###FOR.MS###\DRD FORMS\Master Permit Application 12-19-2006.doc