HomeMy WebLinkAboutBLD2008-00075 IllUILDING PERMIT APPLICAN BLD08-00075
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD08-00075 Received Date: 2/22/2008
SITE ADDRESS: 140 ADMIRALTY LN 364
PORT LUDLOW, 98365
OWNER: TERRY K MC CLUSKEY PHONE: (360) 437-7364
KATHLEEN MC CLUSKEY
140 ADMIRALTY LN UNIT 364
PORT LUDLOW WA 98365-8280 THE ADMIRALTY #2
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 990300222 Section: 9 Township: 28 N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP ADD NEW WINDOW TO LIVING ROOM - NO MLA REQ'D
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP ALT MAIN:
VALUATION 2,000.00 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:
a ) a51c -
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $69.25 KAS 02/22/08 95847 APP
Plan Check $45.01 KAS 02/22/08 95847 IotJEIJ
State Building Code $4.50 KAS 02/22/08 95847 �/
Total: $118.76 FES moo
Jefferson County Planning
Building Department
Permit Num BLD08 00075
Jefferson County Building Div. on Applicant: MC CLUSKEY
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
Framing S. 7 pg � Gr
FINAL INSPECTION
FINAL INSPECTION MUST BE PERM TO SED PRIOR FOR O O BUILDING BEING OCCUPIED
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- SOx !RECEIVED
,9 off, JEFFERSON COUNTY
ro y`., r} DEPARTMENT OF COMMUNITY DEVELOPMENT FEB 2 2 2008
.3 -'. .ii., ''4 621 Sheridan Street• Port Townsend • Washington 98368
360/379 4450 • 360/379-4451 Fax
q www.co.jefferson.wa.us/commdevelopment
s N��° JEFFERSON COUNTY BCD
Master Permit Application MLA: WO t'{LA PE4 I D
Project Description(include separate sheets as necessary): (�
Gi(( i l X 1S If �t' 1.L3 h�A )t W MVt-- �i -0--4J A-.)l Tax Parcel ` \ a 2_2 2_Property
Number: - =-M0 Size: (acres/square feet)
Site Address and/or Directions to Property: 14-0 clort l r.4.# �.�kx -E- 36�f h+ ..`�(1 (o
Property Owner(s)of Record::ke c"\t. � `fir,y�, t3''C ���k,� cX
Telephone:3 60 43�1-1 3 6� Fax: — emailk4 vy t'HprCf C65+Mo .. C%
Mailing Address:5 Ls 2s et 1,-)OIT
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies)
(Building ❑Variance(Minor, Major or Reasonable Economic Use)
p Demolition Permit rj ❑Conditional Use[C(a),C(d),or C]**
d Single Family P DDiscretionary"D"or Unnamed Use Classification
❑Garage Attached/Detached ❑Special Use(Essential Public Facilities)**
El Manufactured Home [Boundary Line Adjustment
d Modular °Short Plat**
❑Commercial* [(Binding Site Plan**
❑Change of Use ❑Long Plat**
Q Address i Road Approach [Planned Rural Residential Development(PRRD)/Amendments**
Q Propane OPlat 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 ❑Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless Telecommunication* []Jefferson County Shoreline Master Program Amendment
❑Forest Practices Act/Release of Six-Year Moratorium
*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:
p� ' � DESIGNATION OF AGENT
I hereby designate AA- .I�.lB t� to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE. Q Q. _ Date: to/- r:k 9 - Zz, 17
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 apdt'cant informs the County in writing at the
time of the plication that he or she wants prior notice. LO
/ 1 (�
Signature: CO—Ok.A4a ` Date: I a—c�cr-0 I`J
The action or actions Applicant will undertake as a result of the issuance is permit may negatively impact upon one or more threatened or
endangered species and could lead to a potential"take"of an endange 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 adhering to and complying th the ESA. Th Applicant h read this disclaimer and signs and dates it below.
Signature: L — 1 V ,Q a- C 1W Date: I — Z`- — 7
D:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05-2.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 b assuming theresponsibility of the General Contractor for the proposed project.
SignatU �"ckt:-.� N-*--( Date: /Z— Z c/ ^ C.) 7
GENERAL CONTRACTOR OR MANUFACTURED HOME INS PHONE: FAX:
( ) ( )
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: ' Bathrooms: Shoreline: Type of Sewage Disposal:
-El' New vJv.t .0 V4,) 0 Wood Existing: ❑Sewer
❑ Addition ❑ Steel Proposed: Bank 0 Community System
❑ Alteration/Remodel 0 Concrete Total: Height: C,]Individual System
❑ Repair 0 Masonry SEP Permit#
❑ Demolition 0 Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well 0 Two Party
Type of Heat: Proposed: 0 Public
Total: Name of System:
0
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 / Np
If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply:
0 Underground Tank 0 Above ground Tank Size of Propane Tank:
0 Heat Stove ❑Cook Stove ❑Woodstove ❑Fireplace Insert ❑Hot Water Tank 0 Pellet Stove p 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:
2nd Floor Heated Consistency Review:
Other Heated Base fee: 19q.
Mezzanine Additional Section: -- -
Heated Basement Plan Check fee:
d v State Surcharge fee:
L5 -o 1
Unheated Basement
Other Unheated J1 Pot Water Review fee:
Garage/Carport FEB 2 2 2.0 SUBTOTAL
1 18. "�
Decks [[( R 911/Rd Approach fee: �^
Other JiiiiVIN G11.10 DCD TOTAL: $ 1 ` .7
�
Receipt Number: (]`5 3 4'7
Cash/Check Number: �"� �, f
ESTIMATED COST(REQUIRED) Date: l/5
.Fair market value of I labor and�a rials foundation to finish al Ag
l� Initials:
D:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05-2.doc