HomeMy WebLinkAboutBLD2009-00318 BLD09-00318
GILDING PERMIT APPLICATON Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD09-00318 Received Date: 9/28/2009
SITE ADDRESS: 634 BYWATER WAY
PORT LUDLOW, 98365
OWNER: STEVEN HENDRICK PHONE: 281-257-1488
YOUNG C HENDRICK
1114 BRINGEWOOD CHASE DR
SPRING TX 773793620 BRIDGE VIEW ESTATE TR DIV III
SUBDIVISION: Block: Lot: 20
PARCEL NUMBER: 821355032 Section: 35 Township: 28 N Range: 01 E
CONTRACTOR: LANDER CUSTOM DESIGNED HOMES PHONE: 360-598-2300
PO BOX 65437
PORT LUDLOW WA 98365
Contractor's License LANDECD022JT Expires 3/25/2010
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOF COU FROM SFR TO OFFICE (BLD04-212) -REMOVE BDRM &
COOKING APPLIANCES
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP COU MAIN:
VALUATION ADD'L: HEAT TYPE: EEE
CODE EDITION: 2006 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
CONST TYPE: DECK:
BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: 1 Exist: 1
Prop: -1 Prop: 0
Total: 0 Total: 1
Routing Date:
i_ ,
Type Amount Paid Bv: Date: Receipt: APR.7 B':-.,NEL
Change of Use or $426.00 LYK 09/28/09 111012 OCT c9-I 2009
Total: $426.00
Jefferson County Planning
&Building Department
Jefferson County Building Dion Permit Nur.:.
Applicant:
BUILDING PERMIT INSPECTION APPROVALS \pplicable Code: International Building Codes
To schedule inspections, call (360)379-4455
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
cen(k a - LCO
FINAL INSPECTION 7/2603 /,;
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
CONDITIONS for Building Permit# :BLD09-00318
1.) The onsite sewage system is not sized for an accessory dwelling unit. The kitchen
facilities and bedroom shall be removed from the structure prior to final approval. Removal
shall be verified by the Building Inspector.
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�. °�,. JEFFERSON C NTY
ti • d 4,, DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax -.7) !fix r 7 ft Oo ,�Lr9&
www.co.jefferson.wa.us/commdevelopment
8nv02/
Master Permit Application MLA:
Project Description(include separate sheets as necessary):
C t- I ,1 cyc. / ',- A i AT RC-
Tax Parcel Number: 8 7-( -- 3SS--0 3 2_ Property Size: 2_,D
3 t sr) ID (acr s/square feet)
Site Address and/or Directions to Property:
lv 3`--k B j c,.. ✓ up at...3 ' o r k LLLrd to uJ t W Pv 913 co c
Property Owner(s)of Record:
Telephone: 28 (- �5 7 ) $ R Fax: o -
`( $- DZ( email:S.(.e_ I t li 3+ncari c.kQcoMtath.
Mailing Address: t 11`-t $r`:.^a vOo o 41 C- ..S-E.. D'cl f - t S e r%:-..J X 7�T 371 ettf'-
Applicant/Agent(if different from owner): Lave lD,4/ C u(.�iv. G
�,S•` riQ� r�nn.e1 T„t ,
Telephone: 3 kg.p_ S1€- 3.3 O C> Fax: 3kaeo- S'q B - 30 2_( email: t r Co (a (a.vud EV e_o s 110,1
Mailing Address: kc3 rsn24• c o M
What kind of Permit?(Check each box that applies ❑Lot or Road Segregation
'wilding ❑Critical Areas Stewardship Plan
0 Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use)
❑ Single Family ❑ 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 ❑ Boundary Line Adjustment
❑ Address 0 Road Approach ❑Short Plat**
❑ Home Business 0 Cottage Industry ❑Binding Site Plan**
❑ Propane 0 Long Plat**
❑ Sign 0 Planned Rural Residential Development(PRRD)/Amendments**
❑Allowed"Yes"Use Consistency Analysis ❑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
0 Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment
*May require a Pre-Application Conference ❑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,IC.Ic Z-v1-,4-2ej(t"4-i to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE ... X f v *. --. /ye.V,,to,e/r& Date: 7- - Z - cD 7
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 sh nts prior noti/
Signature: � �" ` �.�lZ- s Date: 9 - Zr V - 0
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.
Signature: G/ .C"-- /�,1�� Date: 2 - Z e - D,
G:\PemutCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
• •
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 General Contractor for the proposed project.
Signature: Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAx:
LOY-X l�� ` �' ,� ,-; ((3�to0 51 e- Z30o (363 SS$- 30Z
x�T7 7 k A I t S t �- 1� �1,QS.
MAILING ADDRESS: �x 2 Si 3 - IL: ,`h�o Lan,A`tw/C k S4-D.r.11.0 4:f.*el
CONTRACTOR'S LICENSE ?E.a lStp O ,LA7 l• 41310 WAINS
NUMBER: t—A 3.) ...-C1)o 22-3\ NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAx:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New ❑ Wood Existing: 0 Sewer
O Addition ❑ Steel Proposed: Bank 0 Community System
❑ Alteration/Remodel 0 Concrete Total: Height: 0 Individual System
❑ Repair ❑ Masonry SEP Permit#
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: l Setback: 0 Private well 0 Two Party
Type of Heat: Proposed: 40 Public
C_1CC A c 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:
1 Underground Tank 1 Above ground Tank Size of Propane Tank:
i 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 Bld App Review: ,
2"tl Floor Heated q b�iO - Consistency Review:
Other Heated Base fee: C OU /
Mezzanine Additional Section:
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL
,461
Decks 911/Rd Approach fee:
Other TOTAL: $ qq
Receipt Number: \ , `c-)
Cash/Check Number: ���1Le
ESTIMATED COST(REQUIRED) Date:
•Fair market value of all labor and materials foundation to finish
Initials: ,
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
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