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Home My WebLink AboutBLD2008-00226 BUILDING PERMIT APPLICAI N B RD08-00226 Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD08-00226 Received Date: 5/29/2008 SITE ADDRESS: 282332 HWY 101 PORT TOWNSEND, 98368 OWNER: LUCILLE M BROWN TRUST PHONE: (360) 379-1663 % MRS MILDRED NORTHUP PO BOX 927 CHIMACUM WA 98325-0927 SUBDIVISION: Block: Lot: TX 8 PARCEL NUMBER: 902234013 Section: 23 Township: 29 N Range: 02 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP RE-ROOF - NO MLA REQ'D TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL: TYPE OF IMP NEW MAIN: INDUSTRIAL: VALUATION 1,000.00 CODE EDITION: 2006 ADD'L: HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: # OF STORIES: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: NUMBER OF EMPLOYEES: WATER SYSTEM: BATHROOMS: Exist: Prop: Total: Routing Date: Type Amount Paid By: Date: Receipt: APPROVEr Permit $38.75 KAS 05/29/08 100221 Plan Check $25.19 KAS 05/29/08 100221 MAY 0 State Building Code $4.50 KAS 05/29/08 100221 Total: $68.44 Jefferson County Planning &Building Department Jefferson County Building Ditsion Permit Num.: BLD08-00226 Applicant: BROWN TRUST 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 Miscellaneous roof naili:ig _Sv 6r" Lo FINAL INSPECTION S Z1il FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR /�.4`SC�N coo. JEFFERSOIDOUNNiR DEPARTMENT OF COMMUNITY DEVELOPMENT IRFCEI\TED� `d 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax �o� www.co.jefferson.wa.us/commdevelopment MAY 2 9 2008 `3HINa)- Master Permit Application MLA:. Project Description(include separate sheets as qoe ssary): Rio-- rz.6q 1OPC f ST/ O �,t.t: Tax Parcel Property Number: qb ) 2�j� c,t Size: (acres/square feet) Site Address and/or Directions to Property: 262 33 2 4 up( _ Property Owner(s)of Record: Telephone: Fax: email: Mailing Address: l Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies , 1Building t —c - b F 0 Variance(Minor, Major or Reasonable Economic Use) O Demolition Permit 0 Conditional Use[C(a), C(d),or C]** O Single Family 0 Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification 0 Manufactured Home ❑ Modular 0 Special Use(Essential Public Facilities)** ,C.2.'Commercial* 0 Boundary Line Adjustment O Change of Use 0 Short Plat** ❑ Address 0 Road Approach 0 Binding Site Plan** ❑ Home Business 0 Cottagelndustry 0 Long Plat** ❑ Propane 0 Planned Rural Residential Development(PRRD)/Amendments** ❑ Sign 0 Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions** ❑ 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 0 Tree Vegetation 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 its 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. S access and right of entry will be ssumed unless the applicant informs the County in writing at the time of the ap ' tion t t or she nts for tice. Signature: Date: — —C) The action or actions Applicant will undertak as a result of the is ance 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 in compliance with the J erson County development code.The Applicant acknowledges that he,she or it holds individual and non- ansf able rep ibility for dheri to nd complying 'h the ESA. T Applicant has read this disc) imer and signs and re1ow. Signature: Date: "-2C/— O G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc • BUILDER STATEMENT • The signer of this statement does hereby certi that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will ming the espons. ility the eneral tractor or the proposed project. �y Signatur .. 7 Date: ,5�29— �!� GENERAL CONTRACTOR OR MANUFACTURED HOME I TALLER: 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: ❑ New _ood Existing: —0 ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: �dividual System Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: .r Water Supply: Existing: -�Q Setback: ❑ Private well ❑ Two Party Type�at. 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: i Underground Tank i 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: , 2na Floor Heated Consistency Review: Other Heated t1`i 4 ,`'- Base fee: 56. Mezzanine Additional Section: Heated Basement Plan Check fee: a5. let Unheated Basement ': `r1 -i State Surcharge fee: 4 .50 Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL 106•L114 Decks 911/Rd Approach fee: Other p (' O g) 5-� TOTAL: $ (g [IL..I Receipt Number: 1 aoa a\ Cash/Check Number: LA J 2 SST-IMATED COSH gUIRED) Date: n •Fair ma value of all labor all mat vials foundation to finish 5 I o1�`1 o i Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc v