HomeMy WebLinkAboutBLD2009-00081 •IILDING PERMIT APPLIC BLD09-00081
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD09-00081 Received Date: 3/17/2009
SITE ADDRESS: 684 SEAL ROCK RD
BRINNON, 98320
OWNER: KENNETH S BROCKWAY PHONE: 360-636-0383
KAREN F BROCKWAY
3510 PLEASANT HILL RD
KELSO WA 986269719 SEAL ROCK
SUBDIVISION: Block: Lot: 4
PARCEL NUMBER: 992800004 Section: 26 Township: 26 N Range: 02 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI` CONVERT EXISTING CABIN TO UNHTD STORAGE/SHOP-REMOVE
KITCHEN & BATHROOM
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP COU
VALUATION MAIN: 312
CODE EDITION: 2006 ADD'L: HEAT TYPE: UH
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: SETBACK:
DECK: 156
BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: 1 Exist: 1
Prop: -1 Prop: -1
Total: 0 Total: 0
Routing Date:
---21 -(9q
Type Amount Pal By: Date: Receipt: Approved/Date
Change of Use or $426.00 LYK 03/17/09 105577 APPROVED
State Building Code $4.50 LYK 03/17/09 105577 H
Total: $430.50 APR i3 2009
Jefferson County Planning
&Building Department
CONDITIONS for Building Permit# :BLD09-00081
1.) THIS BUILDING APPROVAL BY JEFFERSON COUNTY HEALTH DEPARTMENT IS
FOR STORAGE ONLY, THIS STRUCTURE IS NOT FOR RESIDENTIAL USE OR
HUMAN OCCUPATION.
Jefferson County Buildingivision Permit Niter:
Applicant:
BUILDING PERMIT INSPECTION APPROVALS applicable Code: 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
FINAL INSPECTION % y 1{ 40-0
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
03/10/2009 14: 04 36037940 JEFF CO PERMIT ER PAGE 03/04
+ `cod JEFFERSONDEPARTMENTOF COUNTY
COMMUNITY DEVELOPMENT
621 Sheridan Street• Port Townsend -Washington 98368
4, 4y 360/379-4450 • 360/379-4451 Fax
ir � www.co.jefferson.wa.us/cammdevelopment
Master Permit Application _ MLA: liO 1 \LA Q Q'_N
Project Description(include separate Sheets as necessary):
Tax Parcel Number: - Property Size: (acres/square feet)
Site Address and/or Directions to Property:
t 6l i�i o.1107I G TT tiv1c i &J.
Property Owner(s)of Record: 41 -- .
Telephone: 3ic,0 10 3 L..— t"3C z, Fax: email:
Mailing Address: - qfh?-Lk, "—
Applicant/Agent(if different front owner):.. _
Telephone: Fax: email:
Mailing Address:
What kind of Porn*?(Check each box that applies
lii3Building El Critical Areas Stewardship Plan
❑ Demolition Permit El Variance(Minor, Major Or Reason IWedntxri )
❑Single Family ❑ Garage Attached/Detached ElConditional Use [C(a),C(d),or C]
❑ Manufactured Home ❑ Modular ❑ Discretionary"D"or Unnamed Use Classification
❑ commercial* ❑Special Use(Essential Public Facilities)**
41 Change of Use ❑Boundary Line Adjustment
❑ Address El Road Approach El Short Plat**
❑Home Business 0 Cottage industry El Binding Site Plan'"
❑Propane 0 Long Plat"*
C1 Sign CI Planned Rural Residential Development(PRRD)/Amendments
❑Allowed"Yes"Use Consistency Analysis 0 Platt Vacation/Alteration""
❑Stormwater Management El Shoreline Master Program Exemption/Permit Revisions*"
0 Site Plan Approval Advance Determination(SPAAD)" 0 Shoreline Management Substantial Development"
❑Temporary Use ❑Shoreline Management Variance
El Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment
El Forest Practices Act/Release of Six-Year Moratorium Cl Jefferson County Shoreline Master Program Amendment
`May requite a Pre-Application Conference Cl Tree Vegetation Request
""Requires a Fi e•Appllcation Conference
Please Identify any other local,state or federal permits required for this proposal,if known:
DESIGNATION OF,4GENT
i hereby designate to act as my agent in matters relating to this application for permit(s).
OWNER SIONArunE 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 dry 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 tater Inspections. Staffs access and right of entry will be assumed unless the applicant Informs the County in writing at the
time of the ape! tion that he or he wan prior notice.
Signature: - ,1�4_„ \ __- Date: 2' '/u.2 — Cjy
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 en 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 with the ESA. The Applicant has read this disclaimer and signs and dates It below.
Signature: — Date;
• •
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 neral Contractor for the proposed project. q
Signature: �!� u�'. - 1'?�� Date: -o O U /
GENERAL CONTRACTOR OR MANUFACTURED H E�LER: PHONE: FAX:
A '/L ,9;— Lc/cc. y (340 A, -Ci3 3 ( )
MAILING ADDRESS: / EMAIL:ye
�,S 7G, /'le Cc S<i Lc f A
CONTRACTOR'S LICENSE /<,e i5'p/ (�OSI C Je �._ WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAx:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
_i New & Wood Existing: _I I Sewer
❑ Addition ❑ Steel Proposed: -/ Bank ❑ Community System
Iteration/Remodel Li Concrete Total: ( Height: )51 Individual System
1 Repair C Masonry SEP Permit#
C Demolition r Other: Bedrooms: Water Supply:
Existing: Setback: pl; Private well ❑ Two Party
Type of Heat: Proposed: / ❑ Public
c. , T/ , , 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 1 Fireplace Insert i Hot kNater Tank f 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 F i;.1Ntas s 4 y 9 9Y Ny� ; , ,._ Amount �'�R�avision
Main Floor Heated r, EH Bld App Review:
,- /./ C)
2na Floor Heated , a ,% `: Consistency Review:
Other Heated Base fee:
Mezzanine t Additional Section:
Heated Basement Plan Check fee:
Unheated Basement -: State Surcharge fee:
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL
Decks 911/Rd Approach fee:
/.20s . /2e,,
Other TOTAL: $
Receipt Number:
Cash/Check Number:
ESTIMATED COST(REQUIRED) Date:
.Fair market value of all labor and materials foundation to finish
06'.. --0
0^ •
Initials,:
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29 OR.doc
03/10/2009 14:04 360379 JEFF CO PERMITR PAGE 04/04
JEFFERSON COUNTY PERMIT CENTER.62t SHERIDAN ST, PORT TOWNSEND WA 98368 PH: 360-379-4450
LIFE( FIRE AND CONSISTENCY REVIEW APPLICATION
Please check one: In CHANGE OF USE ! IREVIEW
SITE ADDRESS: 'J
9f f#/ROAD NAME`' `_>ec-i ik_ 'kUa
lie
r` _WA- zip n 3 0
—
9 DIGIT PARCEL ID NUMBER 91 a?coQQ v_
Legal Description:
Subdivision Name Block Lot(s)_�
Section With,th, Range WM
APPLICANT I°Y1V1° gl /a[Li PHONE % G 3W$
MAILINGADDRESS
-e C ,t,-- t,(J 1' ZIP 7{1,22
PROPERTY OWNER S Call P — PHONE
MAILING ADDRESS •
.. ZIP
CURRENT USE(S) \!- c.,a.`t"t X; t I rtli L)L v16-ti. •_ 4
PROPOSED USE(S) tALO ricch.0(,/ �,,1of `L, / l,( ei III FlC- r-1
SEPTIC PERMIT NUMBER IBC OCCUPANCY IBC TYPE OF CONSTRUCTION
Classification Classification
NUMBER OF BEDROOMS NUMBER OF BATHROOMS WATER
PROPOSED _ (; PROPOSED C. Ci Public Water _
EXISTING CI EXISTING I .Iii Private WeN
TOTAL C TOTAL V . 0 2-party Weil
EXISTING#OF PARKING SPACES f OF HANDICAP PARKING SPACES M
CURRENT NUMBER OF OCCUPANTS(includes owners, PROPOSED NUMBER OF OCCUPANTS Grego owners, 1
tenants,employees,etc) _ _ tenants,employees,etc) 0
CURRENT TOTAL SQUARE FOOTAGE(includes decks,porches,outbuildings,shed...etc) - Y6 8 s
PROPOSED TOTAL SQUARE FOOTAGE(includes decks,pouches,outbuildings,shed...etc) ,1 5 -•��",
APPLICANT SIGNATURE //%Zz- 1 DATE 3 V
_,J_LA- IOJ.
FOR OFFICE USE ONLY
$ rr.3.:-
EASE FEE 0,&LL " r i i RECEIPT# i C) s-7-1
STATE SURCHARGE 4.50 CASH/CK# -/(44
TOTAL DATE J / 17 /CC
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