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HomeMy WebLinkAboutBLD2008-00131 fx), --)-7 rwia D/12 --yi(=Lk_ • • BUILDING PERMIT APPLICATION M Review Type: e:I pe:I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD08-00131 Received Date: 4/7/2008 SITE ADDRESS: 284 FARRELL RD QUILCENE, 98376 OWNER: COURTNEY G LAMM PHONE: 360-779-3026 HEIDE M LAMM 5025 NE LAMMS LN POULSBO WA 983708868 BATH SHORT PLAT SUBDIVISION: Block: Lot: 1+ PARCEL NUMBER: 701271006 Section: 27 Township: 27 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTION NSFR W/ATT GARAGE & U/G 500 GAL PROP TANK TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 1,410 VALUATION 228,646.00 ADD'L: 592 HEAT TYPE: PRO CODE EDITION: 2006 HEAT BASE: HEAT TYPE: OCCUPANCY: R-3 OCCUPANCY: UNHEATED: #OF STORIES: CONST TYPE: 5N OTHER: 480 SHORELINE: CONST TYPE: GARAGE: 952 SETBACK: DECK: 20 BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: PWELL BEDROOMS: BATHROOMS: Exist: 0 of Exist: 0 Prop: 1 41 Prop: 1 Total: 1 Total:...__ 1 Routjtjnq Date: _ � A 7 lJ0 Type Amount Paid Bv: Date: Receipt: Approved/Date Permit $1,716.15 LYK 04/07/08 97133 Plan Check $1,115.50 LYK 04/07/08 97133 State Building Code $4.50 LYK 04/07/08 971:33 Potable Water Application $59.00 LYK 04/07/08 971:33 Total: $2,895.15 ECEI S C 1 2 18 April 30th 2008 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, Washington 98368 To whom it may concern: At this time I would like to cancel my application for a building permit at 284 Ferrell Rd., Quilcene, Washington, application was made on April 7th. My name is Courtney Lamm and due to personal problems I would like to cancel this application. If you need to contact me, I can be reached at 360-509-1492. Courtney Lamm 5025 NE Lamms LN Poulsbo, Washington 98370 360-509-1492 courtneylamm(c�gmail.com Sincerely, Courtney G. Lamm ATTEN: Lisa Keller Apr 21 08 12:48p Jon Parrott 3607794378 p.1 I' ' ' L 1 ' ; I i, I I' >ro'' / ' 1 i j 1 I : iii1 1( {T[II IT1ITl n [1�i � I i 1�111�1f111nl1illt1fllUllkll111 Ilium( ill V NMR8'�+hrJ1l1YYVVt111M1�lhtih� Il YI; x ..,i '[ f x YI1 • /J �S ; I I ‘ ,,,,. . 1 i " . it swam I Mall PI , ... CI J vi p ;IL-10%A E.; �rluuwr • . ..rf. E .l • lit t - �f � � ;1 , uuulu gg t Oilii i. mil. in II I. j � I II I C..... ' �*+ '7c -, I , i IrR7 7.1 ` PrF .. VLF . al s. t' NVliN11L^'f GWWT.fJN1{!tih'Yl i! III vl II 1 - s Ii =JWWIRn.'irrrrJI'd11111 4VIMF I H ' flL i I . �w4`'SaN cb JEFFERSON RUNTY W ' � ,�,� DEPARTMENT OF COMMUNITY DEVELOPMENT '� 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax q p www.co.jefferson.wa.us/commdevelopmert S N: Master Permit Application MLA: 02- 1`N Project Descri tion Include separate sheets as necessary): • N R wiill a ched Sara ,e ! 500 . L_4P. Tax Parcel �'] Property Number: ( O I z 7 ' Q O 6 Size: 2 g (acres/square feet) Site Address and/or Directions to Property: 284 edrr . C�2u.ilcibyl 1 Ul/d . 98376 Property Owner(s)of Record: U _ L. yvw i Telephone: 3(30-'779-3p2(a . 360-509-1A92 czl( email:COuY-1haylatnrnt0,9tui1. corn Mailing Address: 5O25 NE L.a►'ntnc L'n, Pac.)(5b6) Vid, 983%, Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: Wh3.t kind of Permit? (Check each box that applies 6Auilding ❑Variance(Minor, Major or Reasonable lwconpr�tic Use ',1tVI .� if-1 ❑ pemolition Permit / Conditional Use[C(a),C(d),or C]** ir`� +`� "`'` ffll�r i_j_ Single Fami ❑ ly 6"Garage LAttached_P`Jetached ❑ Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home 0 Modular ❑Special Use(Essential Public Facilities)** ❑ Commercial* ❑ Boundary Line Adjustment I Jii118 El Change of Use ❑Short Plat** ❑ Address ❑ Road Approach 0 Binding Site Plan** El Home Business ❑ Cottagelndustry ❑ Long Plat** �CpS {'"�� j1(*(]''IJ ropane El Planned Rural Residential Development R A e urh ri u t! ❑ Sign ❑ Plat Vacation/Alteration** ❑Allowed "Yes" Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions** 0 Stormwater Management ❑Shoreline Management Substantial Development** ❑ Site Plan Approval Advance Determination (SPAAD)* 0 Shoreline Management Variance 0 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 ❑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 fad 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 requi d ater i spections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the applicati n t the r s wants prior notice. 4 ^7 ` V 8 Signature: • _ 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 i u are i compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transf ra le res onsbility for adhering to and complying with the ESA. The Applicant has read this disgtaimer and signs antes it below. / Signature: Date: 44 — O c G:\PennitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc 1110 • BUILDER STATEMENT The signer oft ' 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 a u ing t e responsibility of the General Contractor for the proposed project. / Q Signature: • Date: 3 — ? — 0U GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: 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: VNew Wood Existing: Li Sewer Cl Addition ❑ Steel Proposed: I Bank LI Community System ❑ Alteration/Remodel Et/Concrete Total: I Height:, I•+1ndividual System ❑ Repair ❑ Masonry / 10 SEP Permit# 15 C 3 ❑ Demolition ❑ Other: I C F. Bedrooms: Water Supply: Forms Existing: Setback: NY-Private well ❑ Two Party Type of Heat? Proposed: I 1 H Public (-1 I an!G rF Total: I ( OO Name of System: L'P 540VV. 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 t s is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: derground Tank i Above ground Tank Size of Propane Tank: S c,O© a I- VHeat tovte�a11 Cook Stove i Woodstove i Fireplace Insert I Hot Water Tank i Pellet Stove i Other h ydr'a rail 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 1 ni I O )35233 A /ID EH Bld App Review: ` � C�Q 10 Floor Heated s(r72 Consistency Review: c-•- h Other Heated Base fee: 5\b Mezzanine i ' n: ,o. Heated Basement Plan Check fee: `. �� 1, I 1 (0 zir Unheated Basement State Surcharge fee: F Other Unheated 43 12i Ipq° Pot Water Review fee: (` 3 C C6 Garage/Carport ' SUBTOTAL 952 -ZgoiS IS Decks 20 1 911/Rd Approach fee: 504 E Vi1KL nth,,, _ _ TOTAL: $ 'Z3 i Receipt Number: Cl 1 33 4 ( - Cash/Check Number: C� 1 Ao ESTIMATED COST(REQUIRED) V� Date: �(_-7_` c/ .Fair market lue of all labor and materials foundation to finish 1 / O 0 150 Initials: "" � Obi . c_ � �----- - N G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc LA IviivIl 5 1\I EW HOUS .. PI;CPOSA L _ . _ .. ELEV I 35 ' &:- ._ _ • ,. , N itt c_. 2. , 795 A orL,5 NI uLv-cl Vafia-f -ti ari • „ ,14,, .,,,,,,,, c),,...„ ,,„„ ........3, r /-' , \ i II , A Gr-ed I -) Gal . 1 I 4/ I lir- • , 1 , % WELL 1 , It ,0 \,,,,,. \ - . 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