HomeMy WebLinkAboutBLD2009-00241 QUILDING PERMIT APPLICASN MLA09-00251
Review Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD09-00241 Received Date: 7/28/2009
SITE ADDRESS: 395 N BAY WAY
PORT LUDLOW, 98365
OWNER: DAVID ABAD PHONE:
MELISSA DICKINSON
408 WILLOW ST
PORT TOWNSEND WA 98368-6419 OAKBAY WATERFRONT TR
SUBDIVISION: Block: Lot: A+
PARCEL NUMBER: 976800063 Section: 29 Township: 29 N Range: 01 E
CONTRACTOR: WEBER CONSTRUCTION PHONE: (360)385-5204
RAY WEBER
4554 LOPEZ AVE
PORT TOWNSEND WA 98368
Contractor's License WEBERC*0330D Expires 11/29/2010
REPRESENTATIVE: ANDREW REECE PHONE: (360) 385-4305
2310 THOMAS ST
PORT TOWNSEND WA 98368
PROJECT DESCRIPTIOr NSFR W/A/G 250 GAL PROP TANK & GENERATOR
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 1,024
VALUATION 200,000.00 ADD'L: 384 HEAT TYPE: PRO
CODE EDITION: 2006 HEAT BASE: HEAT TYPE: RAD
OCCUPANCY: R-3 UNHEATED: #OF STORIES:
OCCUPANCY:
OTHER:
CONST TYPE: 5N GARAGE: SHORELINE:
CONST TYPE: DECK: 299 SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM: PWELL
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 1 Prop: 2
Total: 1 Total: 2
Routing Date:
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $1,553.75 LYK 07/28/09 108844
Plan Check $1,009.94 LYK 07/28/09 108844
State Building Code $4.50 LYK 07/28/09 108844
Potable Water Application $62.00 LYK 07/28/09 108844
Total: $2,630.19
David Abad and Melissa Dickinson Sr
11 Rhododendron Street
Port Townsend,WA 98368
August 10, 2009
To Whom it May Concern,
This letter is regarding Residential Building Permit #BLD09-241. We are writing to
request a withdrawal of our permit application due to unforeseen personal financial
reasons, and would also like to request a refund of any funds not yet used in the
permit process. Thank you very much. If a partial refund is possible, please send it to
the above address.
We si rely appreciate it.
Melissa Dickinson and David Abad
AUG 1 0 2009
ON c
r'.
°L, JEFFERSON COUNTY
" 4,ADEPARTMENT OF COMMUNITY DEVELOPMENT
- 621 Sheridan Street• Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
.�' p� www.co.Jefferson.wa.us/commdevelopmeriL __ -- •
Ct
Master Permit Application JUL 2 8 2009 MLA: U- -( 1
Project Description(include separate sheets as necessary):
; __J
Tax Parcel Number: v� ( O� .- Property Size:
7 �� Pe Y I r1:12 rs �g �(acres/square feet)
Site Address and/or Directions to Property: M!: ee"
•
Property Owner(s)of Record:
Telephone: Fax: email:
Mailing Address: t , P- q is3K tt ,� 'y(t�� Tc A� T{_7� c�
Applicant/Agent(if different from owner): , �•1 - 1}c�� -, �J �✓�� [A1l�
Telephone: UPC' '';3'430 Fax: email: E
Mailing Address: Z �d ''( �� '�[
Wh.. kind of Permit?(Check each box that applies 0 Lot or Road Segregation
I::uilding 0 Critical Areas Stewardship Plan
❑ p"emolition Permit 0 Variance(Minor, Major or Reasonable Economic Use)
rCeSingle Family 0 Garage Attached/Detached 0 Conditional Use[C(a), C(d),or C]**
❑ Manufactured Home .0 Modular ❑ 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**
lei 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 designs to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE / je2
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 r- d lat: inspections. k�•• s access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the apit
• • 4at ,e • he wa . . otice.
Signature: _ ,. i•t = . Date:
The action or a ions Applicant will undertake as a result of the issuance of this permit may negatively Impact upon one or more th atened 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)ev-• • are • pl the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-tr.nsfer-,M r •• -bil '• :•.-ring to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature �. . �: li ...-..A. .�.�� Date: 7. 1- '" f
• •
BUILDER STATEMENT
The signe o state e does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that
they will be assu •ng t e r sponsibility of the General Contractor for the proposed project.
Signature: - Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
MAILING ADD ESS: .1".
�. � � EMAIL: .•—+
CONTRACTOR'S LICENSE `M WAINS
`
NUMBER: ILc� v NUMBER
ARCHITECT/ENGINEER: PHONE (W ��L"►94 - AX:( )
MAILING ADDRESS: So.; i� • / r� l• Wik , EMAIL L. 4 ��+� '
Proje.d Type: Fra9e Type: Bathrooms: Shoreline: Type of Sewage Disposal:
New Wood Existing: ❑ Sewer
❑ Addition ❑ Steel Proposed: L.- Bank ❑ Cpmmunity System
❑ Alteration/Remodel 0 Concrete Total: 'L._ Height: i5•Individual System
❑ Repair 0 Masonry SEP Permit#
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: fi 'Private well ❑ Two Party
T of Heat: Proposed: �_ ❑ Public ` , „ �Lr5
A Total: l Name of System: (_. r
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 . /or A liance Installation rmit,mark all items below that apply:
i Underground Tank i rove ground Tan Size e Tank: ,g50
i Heat Stove
1 ook Stove-" "oodstove i Fireplace Insert • Hot Water Tan ' I Pellet Stove i Other
Is this appliance '• • •lied in a Manufactured/Mobile Home.
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,sysstent components,
including the reserve area. la1 10 l-
Square Footage Current Proposed For Office llsw#"1Y `t 1#i
1A
Main Floor Heated t�0 1 P�H BId App Review: vr-15-00
2nd Floor Heated 8,(' ic.�2�`�5onsistency Review: . l .co
Other Heated 4//44ZJ
Base fee: 1 5 . '15
Mezzanine ' Additional Section:
-Heated Basement Plan Check fee:• 11 D d q.C. 4.
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Review fee: O +00
Garage/Carport SUBTOTAL aq514' lq
^Decks !a `el 0, A.,'` -1911/Rd Approach fee:
Other I - 1 ( `(1 TOTAL: $ ac3C-4 , iq
Receipt Number: +a St-I-LI
- Cash/Check Number: �t((TT
ESTIMATED COST(REQUIRED) Date: J-
•Fair a ue of all la3aR i d aterials foundation to finish Initials:
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`('.� ABAD / DICKINSON RESIDENCE
-` - 395 North Bay Way Port Ludlow, WA. 98365
ANDY REECE ARCHITECT PORT TOWNSEND,WA.98368 360 385 4305
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ANDY REECE ARCHITECT PORT TOWNSEND,WA.98368 360 385 4305 r
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