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Home My WebLink AboutBLD2009-00362 •UILDING PERMIT APPLICAJN B RD09-00eview p362 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD09-00362 Received Date: 10/21/2009 SITE ADDRESS: 10-4 HARBORVIEW DR PORT TOWNSEND, 98368 OWNER: DANIEL P OWEN TRUSTEE PHONE: 360-774-6930 VICKY L OWEN TRUSTEE 1030 19TH STREET PORT TOWNSEND WA 98368 KALA POINT CONDO#1 SUBDIVISION: Block: Lot: BLD4- PARCEL NUMBER: 964900030 Section: 26 Township: 30 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTION POST REPAIR TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP REP MAIN: VALUATION 516.00 ADD'L: HEAT TYPE: CODE EDITION: 2006 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid Bv: Date: Receipt: � �' r � �EP Permit $38.75 LYK 10/21/09 110970 V Plan Check $25.19 LYK 10/21/09 110970 State Building Code $4.50 LYK 10/21/09 110970 OCT 2009 Total: $68.44 Jefferson County Plannint &Building Department Jefferson Cos my Building sion Permit Nu : Applicant: BUILDING PERMIT INSPECTION APPROVALS Npplicable 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 b Q f�?1 FINAL INSPECTION scxt FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR __ 4J \ JEFFERSO UNTY DEPARTMENT OF COMMUNITY DEVELOPMENT `' 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax • 4.�yS, _,*(5 www.co.jefferson.wa.us/commdevelopment Master Permit Application TM M J pp on MLA: Project Desc�ri tion(include separate sheets as necessary): / )3 f 4 4(k Tax Parcel Number: -� , V ? ) 05� Property Size: (acres/square feet) Site Address and/or Directions to Property: Property Owner(s)of Record: -711f6-c_ Nf- 14 ce�// C� ,J Telephone: 360 .- 7 7 V G� 9'3(6 Fax: email: --z- 6i,-k-J 0-,C.OM Mailing Address: /03(7 /5 r-e-r 5 T 4,e r w,i).>, �) 6(.4.5' ? 3 a Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies ❑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 ❑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 Facilities)** ❑ Change of Use 0 Boundary Line Adjustment ❑ Address 0 Road Approach_ 0 Short Plat** 0 Home Business 0 Cottage Industry ❑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** 0 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 ❑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 to act as my agent in matters relating to this application for permit(s). LOOWNER SIGNATURE r 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 provi. -cces d r' of e o Jefferson County and its employees,representatives or agents for the sole purpose of application review and any requ• -. .ter' s ' ns affs :mess and right of entry will be assumed unless the applicant info :the ounty in writing at the time of the applicati he or h is • for .tire. Signature: / - Date: 2/ £ 7 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 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 t viol the SA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if yo ar i o pf n ith the Jefferson County development code.The Applicant acknowledges that h ,she or" holds individual and non-transfer le r n bi ty r dh ing to and complying with the ESA. The Applicant has read this disclaimer n ,sign and dates it below. Signature: 0 �- Date: (G. G / O / G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc MEM BUILDER STATEMENT• • The signer of this eme d es e y . that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be ass min th re on ID*• - eneral Contractor for the proposed project. . / - Signature:, Date: (� (/7 ( (/ FAx: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: ( ) ( ) 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: ❑ New ❑ Wood Existing: ❑ Sewer ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel Additionaion/Remodel ❑ Concrete Total: Height: ❑ Individual System — SEP Permit# ❑ Repair ❑ Masonry ❑ Other: Bedrooms: Water Supply: • Demolition Existing: Setback: ❑ Private well ❑ Two Party Proposed: ❑ Public Type of Heat: Total: Name of System: If this is a Commercial Project you must answer the following: Number of ADA Parking Spaces: Number of Parking Spaces: Current: Proposed: Proposed Number of occupants(includes owners,tenants,employees,etc) Current p Type Occupancy: IBC T e 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 1 Above ground Tank Size of Propane Tank: 1 Heat Stove 1 Cook Stove 1 Woodstove 1 Fireplace Insert 1 Hot Water Tank 1 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 bm itasite plan showing all of the buildings,all property lines, tank location and size,distances from the propane tank to all roe lines,buildings and septic system components, including the reserve area. Square Footage 1 Current Proposed For Office Use Only Amount Revision Main Floor Heated EH BId App Review: 2n6 Floor Heated Consistency Review: __ __ Other Heated Base fee: Mezzanine Additional Section: Heated Basement Plan Check fee: �`r-:,' (C.f J Unheated Basement State Surcharge fee: I 50 Other Unheated Pot Water Review fee: _—_ Garage/Carport SUBTOTAL in `l t( ,3 • 1 Decks 911/Rd Approach fee: Other TOTAL: $ ( c* ,44 Receipt Number: 6 / 0 / 76 Cash/Check Number: / Z SU ESTIMATED COST(REQUIRED) Date: /G�,Z l —0•Fair market value of all la oundatio to finish �� 5 /6 Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc