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HomeMy WebLinkAboutBLD2008-00278 tILDING PERMIT APPLICATIN MLA08-00311 Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD08-00278 Received Date: 6/25/2008 SITE ADDRESS: 140 3RD ST PORT HADLOCK, 98339 OWNER: DANIEL S COULTER JR PHONE: 360-385-6072 JENNIFER COULTER 140 3RD ST PORT HADLOCK WA 983399503 PHILLIPS TO IRONDALE SUBDIVISION: Block: Lot: PARCEL NUMBER: 986400701 Section: 2 Township: 29 N Range: 01 W CONTRACTOR: MD CONTRUCTION PHONE: 360-385-4509 MELVIN COULTER PO BOX 225 PORT HADLOCK WA 98339 Contractor's License MDCON**084I34 Expires 8/31/2008 REPRESENTATIVE: MD CONSTRUCTION PHONE: 360-385-4509 MELVIN COULTER PO BOX 225 PROJECT DESCRIPTION NEW 768 SF DETACHED GARAGE TYPE OF WORK GAR SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 0 VALUATION 10,000.00 ADD'L: HEAT TYPE: EEE CODE EDITION: 2006 HEAT BASE: HEAT TYPE: OCCUPANCY: OCCUPANCY: UNHEATED: #OF STORIES: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: 768 SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: OTHER BEDROOMS: BATHROOMS: Exist: 3 Exist: 1 Prop: 0 Prop: 1 Total: 3 Total: 2 Routing Date: n ,r> Co_ Type Amount Paid By: Date: Receipt: Approved/Date State Building Code $4.50 AMS 06/25/08 100432 Permit $186.50 AMS 06/25/08 100432 Plan Check $120.81 AMS 06/25/08 100432 Total: $311.81 SON II •• J �'' .e - k. coff, JEFFERSON COUNTY l`?,; :1_:.L, R. , W DEPARTMENT OF COMMUNITY DEVELOPMENT '-' ` `4 621 Sheridan Street • Port Townsend •Washiigton 98368 .�(�N LU��I l rj 2003 360/379-4450 • 360/379-4451 Fax 1S IiiNdp www.co.jefferson.wa.us/commdevelopment JEFFESON Master Permit Application MLA: c — 3 ► , 1 I p�Q Project Description (include separate sheets as nec.essary): ' £ ;$-.J'.- Z //3 L Tax Parcel dair6 gee 7 / Property r-t Number: �s�✓ Size: ?P 2? i-4 (acres/square feet) Site Address and/or Directions to Property: // /.O-i~� 3 �� 74 J) clC Property Owner(s)of Record: P J0-A//2= 2 CD GA I.J __K Telephone: .3g"4= [,O? L Fax: email: Mailing Address: J A 0` 3 vc1_. Applicant/Agent(if different from owner): 4'7 L> '04,4 Telephone: j'2 5- y 5-4 1' Fax:� email: Mailing Address: i' ,13 2Z S' Li4d I QCl..1 C ,?j, What kind of Permit? (Check each box that applies ❑Building ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit 0 Conditional Use[C(a),C(d),or C] ** Iii Single Family _jGarage Attache Detached El Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home ❑ Modular 0 Special Use(Essential Public Facilities)** ❑ Commercial* 0 Boundary Line Adjustment ❑ Change of Use ❑ Short Plat** ❑ Address ❑ Road Approach El Binding Site Plan** 0 Home Business 0 Cottagelndustry ❑Long Plat** ❑ Propane 0 Planned Rural Residential Development(PRRD)/Amendments** ❑Sign ❑ Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions** ❑Stormwater Management ❑Shoreline Management Substantial Development** 0 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 designate ('&41• to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Q DzsJ2. Date: ( , "'. - -(}B 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 attomey'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 an required later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the a.' cation that .- or sh- wants prior notice. Signature: t : . - . f . _ Date: `..2 (>a 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 in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-tran able resp ibility for adhGrjrlq to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature:y �,A �t. _.': —. Date: e.,.-, — 3 aR • • 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 be assuming the responsibility of the General Contractor for the proposed project. Signature: Date: - GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: A i) Co-1r,.�.1: Gd )3 'W —w n 1 ( ) MAILING ADDRESS: !M el A D e o 4) et*. 0 g' &l a‘Y EMAIL: CONTRACTOR'S LICENSE � WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: 0 New A Wood Existing: / ❑ Sewer Addition ❑ Steel Proposed: / Bank 0 Community System ❑ Alteration/Remodel 0 Concrete Total: 2. Height: y Individual System 0 Repair ❑ Masonry SEP Permit# 0 Demolition 0 Other: Bedrooms: Water Supply: Existing: ,3 Setback: ❑ Private well ❑ Two Party Type of 1-leat: Proposed: 0 A Public e%/r'/ri C Total: 3 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 l 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 ivttCe;i1 y 11 Main Floor Heated 'f - - .? EH Bld App Review: roes p�'c\ `r\ ea Floor Heated r Consistency Review: FetG P0.i cl 1i-N Other Heated Base fee: I c� GJ a Mezzanine Additional Section: lJ Heated Basement Plan Check fee: I aO ' ' Unheated Basement State Surcharge fee: ► 1 . 50 Other Unheated Pot Water Review fee: "Fe tS Pk'`t t v, 2JL o p?, Garage/Carport .a gar' 7z 1113`1G ,coy SUBTOTAL 3 i l . cz,t Decks 911/Rd Approach fee: 1 A 1 �J 1 Other TOTAL: 4 '3 1 I ,15 Receipt Number: t�� Cash/Check Number: ��, -1 ESTIMATED COST(REQUIRED) Date: (/l� •Fai rket value of all labor and materials foundation to finish l CJ / �f 0 0 Initials: (•\PermitCenter\###FORMS###\D1 D FORMS\Mger Per Annliratinn 19_10_7(N11 ri.. G.._ • r-r-, ‘-'••• ' , --r•-• ,.,•• , --r-i r-r•-1 t,... .--- ' 1 •-•—\ , . ,,... P...), . 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