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Home My WebLink AboutBLD2009-00289 likUILDING PERMIT APPLICA BLD09-00289 �N Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD09-00289 Received Date: 8/26/2009 SITE ADDRESS: 5Q CASCADE PL#102 cart' Uudlow w/q 83t f) OWNER: MARK G NELSON JR PHONE: 360-437-7102 BONNIE F NELSON PO BOX 65171 PORT LUDLOW WA 98365-0171 THE ADMIRALTY SUBDIVISION: Block: Lot: 25 PARCEL NUMBER: 990300125 Section: 9 Township: 28 N Range: 01 E CONTRACTOR: B PARKER ENTERPRISES PHONE: 206-818-4184 70 MERIDETH STREET PORT LUDLOW WA 98365 Contractor's License BPARKPE925BG Expires 1/7/2010 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP RE-ROOF OF BLDG AT 50 CASCADE PLACE TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 11,882.00 ADD'L: HEAT TYPE: CODE EDITION. 2006 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $209.25 LYK 08/26/09 110836 Plan Check $136.01 LYK 08/26/09 110836 State Building Code $4.50 LYK 08/26/09 110836 Total: $349.76 Jefferson County Building Dilion Permit Num. Applicant: BUILDING PERMIT INSPECTION APPROVALS \pplicable 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 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 056e," eLy FINAL INSPECTION , , FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR • ,�w�•sp cOL JEFFERSONWUNTY GI ' A DEPARTMENT OF COMMUNITY DEVELOPMENT '' ` `4 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax www.co.jefferson.wa.us/commdevelopment `SHING�S Master Permit Application MLA: K)r) (1. A 17 EQ Project Description 'nclude separate sheets as necessary): \-C4 OTIAP Tax Parcel Number: Q� no Property Size: (acres/square feet) Site Address and/or Directions to Property: Property Owner(s)of Record: Telephon69LD 411 - 1\O Fa email: Mailing Address Wtr'.jF. (oS \`' . Aj 00_314 Applicant/Agent(if different from owner): V Telephone: - -0S- ., Fax: email: M C A Mailing Address: Q ,��J OIL Vi ,s 1 car'\ What kind of Permit' (Check each box that ap lies ❑Lot or Road Segregation ilding �..p� -- e ❑Critical Areas Stewardship Plan ❑ Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family ❑ Garage Attached/Detached ❑Conditional Use[C(a), C(d),or CI** ❑ Manufactured Home ❑ Modular 0 Discretionary"D"or Unnamed Use Classification ❑ Commercial* ❑Special Use(Essential Public Facilities)** ❑ Change of Use ❑ Boundary Line Adjustment ❑ Address ❑ Road Approach_ 0 Short Plat** ❑ Home Business ❑ Cottage Industry ❑Binding Site Plan** ❑ Propane ❑Long Plat** • ❑ Sign ❑ Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes" Use Consistency Analysis ❑Plat Vacation/Alteration** ❑ Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions** ❑ Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development** ❑Temporary Use ❑Shoreline Management Variance ❑Wireless Telecommunication* ❑ Comprehensive) ryi tJDclanc se District Map Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson Count Shoeli a qro ram 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\�� ,p to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: �l 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 application that he or she ants p ' n •e . Signature: Date: The action or actions Applicant will undertake as a result of th issuance of this permit may negatively impact upon on or more threatened or endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the tederal 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 w' • .- --- .• ounty development code.The Applicant acknowledges that he,she or it holds individual and non-transfera.e respo ility for :dherig to and compl •ng with the ESA. The Applicant has read this disc i er and sign and dates it below. Signature: - � _, Date: �2--I0 sign 1 G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc • 410BUILDER 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 CO CTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: MAILING ADDRESS: el0 k\NQ17. ,O,�` `L. � `�1 fJ if . c 2 CONTRACTOR'S LICENSE �" 4W-.A NS NUMBER: cc N ci` f�eC' ek' s 'G NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ 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 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: 1 Heat Stove i Cook Stove i Woodstove i Fireplace Insert i Hot Water Tank 1 Pellet Stove 1 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 Main Floor Heated EH BId App Review: 2nd Floor Heated Consistency Review: Other Heated Base fee: : " Mezzanine Additional Section: Heated Basement Plan Check fee: o Unheated Basement State Surcharge fee: " <- 1 Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: $3( I'. r�j Receipt Number: i I OS 3 Cash/Check Number: I , 9 ESTIMATED COST(REQUIRED) Date: �(�i ��C .Fair market value of all labor and materials foundation to finish _ / I _ v\ ts9 Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc 4