HomeMy WebLinkAboutBLD2009-00177 ItUILDING PERMI
Jefferson County Department of Community Development Review Type;
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD09-00177
SITE ADDRESS 191Received Date: 6/18/2009
ROBIN LN
PORT LUDLOW, 98365
OWNER: JENNIFER BATES
PO BOX 661 PHONE: 360-385-1538
CHIMACUM WA 98325
SUBDIVISION: BRIDGEHAVEN DIV 8
PARCEL NUMBER:
935900016 Section: g Block:
Township: 27 N Lot: 16
CONTRACTOR: OWNER/BUILDER Range: 01 E
PHONE:
REPRESENTATIVE:
PHONE:
PROJECT DESCRIPTIOt REPAIR & REPLACE EXISTING 2ND STORY
DECK
TYPE OF WORK NON
TYPE OF IMP SQUARE FOOTAGE:
VALUATION DEK
,042.00 MAIN:1
ADD'L:
CODE EDITION: 2006
OCCUPANCY: HEAT BASE: HEAT TYPE: UH
OCCUPANCY: UNHEATED: HEAT TYPE:
CONST TYPE: OTHER: #OF STORIES:
CONST TYPE: GARAGE:
SHORELINE:
DECK: SETBACK:
SEWAGE DISPOSAL:
WATER SYSTEM: BANK HEIGHT:
BEDROOMS:
--- BATHROOMS:
Exist: 0 Exist: 0
Prop: 0 Prop: 0
Total: 0 Total: 0
Routing Date: ,___-
—
- ) LT_
typeThOLYKO6/18/0910862
d
f3v: Date: Receipt: Approved/Date
Ian Check
Mate Building Code $27.18 LYK 06/18/09 108621
$4.50 LYK 06/18/09 108621
Total: $73.48
Jefferson County Building "Lion Permit Null,: BLD09-00177
Applicant: BATES
BUILDING PERMIT INSPECTION APPROVALS Npplicable 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 clay'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 1 - _69 Wi
FINAL INSPECTION 7 ANS ,( —
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
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JEFFERSON COUNTY •
I DEPARTMENT OF COMMUNITY DEVELOPMENT
` P4 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
pT www.co.jefferson.wa.us/commdevelopment
iIN�
Master Permit Application MLA: k O Mc A i.b
Project Description (include separate sheets as necessary):
k'ep• ,.-. „ /cvJ,i.cr ric /'v-- Q . c /C
Tax Parcel Number: 931-9 0 o O /L Property Size: ,, L`/ a c--e- (acres/square feet)
Site Address and/or Directions to Property:
l9/ 66, - LN- J.•-4 L... 4/ ,v,-/T c C2,S6 _s,-
Property Owner(s)of Record: e . 4.. •-S..-t-�p
Telephone:1t a ) -)----f r 3 e Fax: email:
Mailing Address: */ /-i;/d A J-/- <A, .,,.-,i c, 4 .I, , l,✓9..- 5'. 3-2_I
Applicant/Agent(if different from owner): ' e ,t ,,., ' . '
Telephone: Fax: email:
Mailing Address: - .
What kind of Permit?(Check each box that applies 0 Lot or Road Segregation
Building 0 Critical Areas Stewardship Plan
❑ Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use)
❑ 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 Fgcilities)**
❑ Change of Use 0 Boundary Line Adjustment v lwr I O 2009
❑ Address 0 Road Approach 0 Short Plat**
❑ Home Business ❑ 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"
0 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:
p[� DESIGNATION OF AGENT
I hereby designate aaera-,.c r l e de) to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE
J1‘ ):7°I. Date: `0/3 (}1
form,the own r/
By signing this applicationagent 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 application that he or she wants prior notice.
ignature: 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 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.
'ignature: Date:
!:-\Pa...-;, ,..,rP.\±H±±tr.nRMS 44\TIRTI P(IRMc\Cnr,," F)RTI P,,rn \Macy,..- .,;r Annhrar:nt,c_9Q_/1Rrinr '
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 assumin the responsibility o the eneral Contractor for the proposed project.
Signature: Date:
GENERAL CONTRAC OR 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:
0 New ,9 Wood Existing: ❑ Sewer
❑ Addition 0 Steel Proposed: Bank ❑ Community System
❑ Alteration/Remodel 0 Concrete Total: Height: 0 Individual System
Repair 0 Masonry SEP Permit#
❑ Demolition 0 Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Party
Type of Heat: 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 FoodSeririce? 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 F,s r Office Use`O.nI , , . Amount ` ,,;Reviaiotl _
Main Floor Heated EH BId App Review: ,
2r4 Floor Heated Consistency Review:
Other Heated Base fee: GG11
4 i. OV
Mezzanine Additional Section:
Heated Basement Plan Check fee: f
C _
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL r']
Decks 911/Rd Approach fee: 1 �
/4 �� PP
Other TOTAL: $ 113 4(
Receipt Number: togam
Cash/Check Number: Ur ��.
ESTIMATED COST(REQUIRED) Date: �J
•Fair market value of all labor and materials foundation to finish (0-t
i , LII etP Initials:
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
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