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HomeMy WebLinkAboutBLD2008-00359 ItILDING PERMIT APPLICA•N BRDOW Type: I 003359 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD08-00359 Received Date: 8/7/2008 SITE ADDRESS: 1881 ANDERSON LAKE RD CHIMACUM, 98325 OWNER: SYLVIA ZIMMERMAN PHONE: (503) 297-4644 6960 SW POINTER RD#310 PORTLAND OR 97225 SUBDIVISION: Block: Lot: PARCEL NUMBER: 901103008 Section: 10 Township: 29 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP BATHROOM REPAIR/ 1�'1t-cettX Hlioo V-t15) Stc.- 11V TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP REP VALUATION `1,5247 60 ADD'L: HEAT TYPE: EEE CODE EDITION: 2006 HEAT BASE: HEAT TYPE: WOD OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: PWELL BEDROOMS: BATHROOMS: Exist: 2 Exist: 1 Prop: 0 Prop: 0 Total: 2 Total: 1 Routing Date: 2// /400 Type Amount Paid By: Date: Receipt: Approved/Date Permit $57.05 KAS 08/07/08 102456 JDIDR ) JEJ Plan Check $37.08 KAS 08/07/08 102456 State Building Code $4.50 KAS 08/07/08 102456 AUGaq 2008 Total: $98.63 Jefferson County Planning & Building Department Jefferson County Building I,. sion Permit Num.: BLD08-00359 Applicant: ZIMMERMAN BUILDING PERMIT INSPECTION APPROVALS applicable 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 Fe n Footing 9(rt C0�� m 6c.010" otk �•` `Robb 0____,, 6citY\QalQ n ttwt 1-100D V -, FINAL INSPECTION u_)../0,tp FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR N • kg LI5 7.—.7 i 2 00 lr • /4 07--F F____ / , __s, ,\N,Nix. , tu viL l Sy 1✓;6--C im 9 Cv,'n ) LA" r / ....ae. r ..., kr U12 7101))2ESS ` r 6,q 4.0 sit) 4 ihkr,etk ' j ../ Po(flood) 012- ___,__. _ , ..,. ,.i,..., ,A.,__, , _ _,,,_,_, , 5 03 21� Lf.6� H w, '1..______ , �,fi .,)/ ... "c q70 gGI peek j j,,• t'`! 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JEFFERSON UNTY it, , v.,3 DEPARTMENT COMMUNITY DEVELOPMENT • '' 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax ,gspcsp www.co.jefferson.wa.us/commdevelopment Master Permit Application ~,r: 1 2008 MLA: 140 MLA EQ 'D Project Description (include separate sheets as necessary): li Nii ON ';t[� ti 13 ,COflw, reeti►Y _ Tax Parcel Number: q 0 I I©?j Property Size: Z, C'/ ac s/square feet) Site Address and/or Directions to Property: G%to) r1 N3t ,Dr. -fD A /J8/ Andeli, Ld� , t_/G u/h19-Guru Property Own�er(s)of Rect6rd: 5 y vJ'c Zlrn rnerr,a v, — 1�/ate Telephone(5Q3) 2 6/6, 9719 96/ -Fax: email: Sy/,r2 nA.ye,o£CL JS,l -- Mailing Address: Mb D St.J Po,►,i4fl/2-11.) #3/v p Ph / DaTG N►7 / p(L q .�Z2 Applicant/Agent(if different from owner): r Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies B ,p Building �,j/ 0. t'ee/-A1,,;,.-r\ 0 Critical Areas Stewardship Plan ❑ Demo itiofi Permit 0 Variance(Minor, Major or Reasonable Economic Use) 2-Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a),C(d),or C]** ❑ Manufactured Home 0 Modular 0 Discretionary"D"or Unnamed Use Classification ❑ Commercial* 0 Special Use(Essential Public Facilities)** ❑ Change of Use 0 Boundary Line Adjustment ❑ Address 0 Road Approach 0 Short Plat** ❑ Home Business 0 Cottage Industry 0 Binding Site Plan** 0 Propane 0 Long Plat** ❑ Sign 0 Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes" Use Consistency Analysis 0 Plat Vacation/Alteration** ❑ Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions** ❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development** ❑Temporary Use 0 Shoreline Management Variance ❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference 0 Tree Vegetation Request **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 104- 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. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the a pticati9n that he or "he wants prior notice. Signature: /✓ Date: .7 Z o The action or actions Applicant will undertake as a result of the issuance oft is 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-tra�rabl�ibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: Date: 7/..74 /Qr- G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc 0 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 a timing the responsibility of the General Contractor for the proposed project. n Signature: Date: 7(Zq I. GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: {'a,Y ( ) ( ) 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 IL-Hood Existing: _ I _ ❑ Sewer ❑ Addition ❑ Steel Proposed: ()_ Bank ❑ Community System 0 Alteration/Remodel ❑ Concrete Total: i Height: R-Individual System Z"Repair ❑ Masonry N i:� SEP Permit#Sw Pc B-CC c Bedrooms: 38 pp y: ❑ Demolition ❑ Other:,__._ �� ,� Water Su Existing: Setback: a Private well LI Two Party Type of Heat: Proposed: ��� ❑ Public �)/b,ar6sar�1 c1iS�}r,Y., Total: �,�- Name of System: If this is a Commercial Project you must answer the following: Number of Parking Spaces: Current: t.1, %‘' Proposed: Number of ADA Parking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current 6 Proposed IBC Occupancy: ti'4- 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 tl J-t-- 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 l ia3/Oq Main Floor Heated EH Bld App Review: '76.00 2nd Floor Heated Consistency Review: Other Heated Base fee: i a5.a5 5-1 .D5 '7L 00 Mezzanine Additional Section: Heated Basement Plan Check fe ►.91 31.v8 °ll. 00 Unheated Basement -,{, State Surcharge fee: 41 -SO Other Unheated Pot Water Review fee: Garage/Carport r fl l:�F'i 1,t SUBTOTAL 168 , 3 ILADc)o Decks 911/Rd Approach fee: • Othebam. (e'a i Y X 66?(6 TOTAL: $ ,(0 El•Lo 3 1 `1�.CO (itt ii>T) Receipt Number: I b Dta 5(0 t 0'78 1 Cash/Check Number: 51 Co3 1 d0 ESTIMATED COST(REQUIRED)� a _ Date: d� OpVQ15/07 .Fair market v nd rr►e als dation to D D /C2y- 6 J _ �7 act Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc 1:1vrn .lA:cocncn ma- A `ic) Cw zro a,�� i m� r �� pZ�y mm�0GO m". � . . 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