HomeMy WebLinkAboutBLD2008-00032 ObILDING PERMIT APPLICA1SN B RD08-00032
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD08-00032 Received Date: 1/28/2008
SITE ADDRESS: 2802 CLEARWATER RD
FORKS, 98331
OWNER: MATTHEW S HOVEY PHONE: 360-962-2255
2802 CLEARWATER RD
FORKS WA 983319301
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 412191005 Section: 19 Township: 24 N Range: 12 W
CONTRACTOR: KILWEIN CONSTRUCTION INC PHONE: 360-538-0274
PO BOX 1133
ABERDEEN WA 98520-0227
Contractor's License KILWIC1044CW Expires 2/1/2010
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI REPLACE MASONRY & VENEER DUE TO FIRE DAMAGE - EXISTING
WOOD STOVE TO REMAIN
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION 6,980.00 ADD'L: HEAT TYPE:
CODE EDITION: 2006
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
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:
Type Amount Paid Bv: Date: Receipt: Approved/Date
Permit $139.25 LYK 01/28/08 95905 APPROVED
Plan Check $90.51 LYK 01/28/08 95905
State Building Code $4.50 LYK 01/28/08 95905 FEB \-4 7O08
Total: $234.26 Jefferson County Planning
&Building Desartment
Jefferson County Building Dion Permit Numb BLD08-00032
Applicant: HOVEY
BUILDING PERMIT INSPECTION APPROVALS \pplicable 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
Miscellaneous rFIRST 4 FOOT LIFT INSPECTION
FINAL INSPECTION -21-7_401 F s
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
�( ON \ JEFFERSOIUNTY, ,.
y � DEPARTMENT OF COMMUNITY DEVELOPMENT
` '.I 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
�q•S�NG�S O'� www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: t) 1Y)L K. h
ject Description (include separate sheets as necessary): C
.e- k -c- C� e ct. - c L\ v`c.v ....),,..._...._4-- �V-� -o �t 4 e...nn4.4,
Tax Parcel Q I �� Property
Number: 1 i 2 I Size: (acres/square feet)
Site Address and/or Directions to Property: k 4�c�:o S
F.Z. C'_1.ta..- A.�.c J
Q . Dc�,SIAacl`k' � \-1 .1n-ea.
Property Owner(s)of Record: Nt TMEL%) H0VE r
Telephone: 3L D cCO 2 2r2SS Fax: email:
Mailino Address: 2 a CLE.A R-WA T t r2,p FOLKS 1 LA ]83'31
Applicant/Agent(if different from owner):' K 1 LW t€.r. Q,04.) S T C ILertt)
Telephone: 3 j S 3. Oa-')4 Fax: tt7 S 3� 0 0 email:KiLtAlt 6,As 'NH.C�(o��
Mailing Address: 1r.D1 bCA. 1,133 46.Ei•.0 . AN 0-eg52-0 CO MCA a ,r.)e t-
What kind of Permit? (Check each box that applies .
❑Building 0 Variance (Minor, Major or Reasonable Economic Use)
❑ Demolition Permit 0 Conditional Use [C(a), C(d),or C]** it-cc
ASingle Family 0 Garage Attached/Detached I: Discretionary"D"or Unnamed Usl9lassift�a4trA V ri
O Manufactured Home ❑ Modular ❑ Special Use(Essential Public Faciifles)*4
❑ Commercial* 0 Boundary Line Adjustment
❑ Change of Use 0 Short Plat** ,AN 2 g 2008
❑ Address ❑ Road App roach ❑ Binding Site Plan**
❑ Home Business 0 Cottagelndustry 0 Long Plat**
❑ Propane ❑ Planned Rural Residential Development(PR / rt n
❑ Sign ❑ Plat Vacation/Alteration ** cI �[ ` WM
0 Allowed "Yes" Use Consistency
Analysis
sis 0 Shoreline Master Program Exemp ti I evisions**
❑ Stormwater Management 0 Shoreline Management Substantial Development**
❑ Site Plan Approval Advance Determination (SPAAD)* 0 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 ❑ 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 designat \�1�r gyp•••- , �-..0, to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE 1�/t Wi .V.11:4\a Date: I
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 purpssb of application
review and any requiredlater inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the ap lication that he or she w nts prior notice.
Signature: �. �IA _V�� 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
"End-.: - .ecies Act"or"ESA."Jefferson County makes no assurances to the applicant that Ole actions that will be undertaken because this
perm t has been is •-d 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 ar- 'n compliance with the Jeffer o County development code.The Applicant acknowledges tat he,she or it holds individual
and n• - -. ; esp,nsibility for ad;ring{o an p ing with the ESA. The Applicant has read this disclairtier an signs and dates it below.
Signat kb, , ' . . Date: t / ZOD,
l' kith 0 O
G:APerrr enter\###FORMS# RD FORMS\Master Permit Application 12-19-2006.doc
` • BUILDER STATEMENT •
The s gner is 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 ass ina the responsibility Qf the t neral Contractor for the proposed projpct.
Signature: Date: — —
GENERAL CONTRACTOR OR MANUFACTU,D HOME INSTALLER: PHONE: FAX:
K\ (.),•J i 12-3 aS't le,_\ /�y��_Q. c fi r\ (3W) S3$1-o -1`). (3100) 53 2— jQL
MAILING ADDRESS: 00. bo. l 13 N 3 ��C. V�j ) � EMAIL: p L W L.'..L.1 COJS-c(u.„....rt JQGor,C,pb.1,)
CONTRACTOR'S LICENSE WAINS
NUMBER: l<1 1_1n) I 'C tO 4d4 G\ NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX: ( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
Li New ❑ Wood Existing: ❑ Sewer
Addition ❑ Steel Proposed: Bank ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual,lik"Repair ❑ Masonry SEP Permit#
n Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Party
Type of Heat: Prop osed: ((� [[
\J0 D Total: N4 IVIl� '1
If this is a Commercial Project you must answer the following: o 2009
Number of Parking Spaces: Current: Proposed: Number of ADA Parking SA:
v
Number of occupants (includes owners,tenants, employees,etc) Current Proposed �f (�
IBC Occupancy: IBC Type of construction: Will you have Food Service[ m nu I I{� DCI
If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply:
i Underground Tank 1 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 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 EH Bld App Review:
2fa Floor Heated Consistency Review:
•
Other Heated Base fee:
Mezzanine Additional Section:
Heated Basement Plan Check fee: CIO
51
Unheated Basement State Surcharge fee: 4
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL 6734
Decks 911/Rd Approach fee: ,
Other TOTAL: $J31i .
Receipt Number: o05
Cash/Check Number: '14 I
ESTIMATED COST(REQUIRED) Date: -)
•Fair a et valueofa#Iaborandmaterials foundation to finish
1� L �� � Initials:
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc J