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Home My WebLink AboutBLD2010-00149 OUILDING PERMIT APPLICA•N B RD10 00eview p14 9 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD10-00149 Received Date: 5/10/2010 SITE ADDRESS: 20 FAIRWIND CT PORT LUDLOW, 98365 OWNER: JEFFREY V LACKEY PHONE: 360-437-4048 SABRINA C CORONA LACKEY 20 FAIRWIND CT PORT LUDLOW WA 983659551 LUDLOW POINT VILLAGE DIV 1 SUBDIVISION: Block: Lot: 1 PARCEL NUMBER: 969400001 Section: 16 Township: 28 N Range: 01 E CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTION FOUNDATION DRAIN REPLACEMENT TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP REP MAIN: VALUATION 1,020.00 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: ( tal: Routing Date: -"— it) --IC Type Amount Paid By: Date: Receipt: Approved/Date Permit $41.80 LYK 05/10/10 117665 Plan Check $25.08 LYK 05/10/10 117665 APPROVED State Building Code $4.50 LYK 05/10/10 117665 Total: $71.38 MAY ci l010 Jefferson County Planning &Building Department Jefferson County Building 'lion Permit Nulikr: BLD10-00149 Applicant: LACKEY BUILDING PERMIT INSPECTION APPROVALS \pplicable 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 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 Footing Drains Drywell/Alt Drainage FINAL INSPECTION 4140 FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR WIII iiiINNeq, JEFFERSONOUNkiii` DEPARTMENTOFCOMMUNITY DEVELOPMENT " 621 Sheridan Street• Port Townsend •Washington 98368 44 �� 360/379-4450 • 360/379-4451 Fax www.co.jefferson.wa.us/commdevelopment 110 Cs Master Permit Application MLA: L'W raik ,d Project Description(include separate sheets as necessary): Tozm. 7ra_LV DAWN /?Fp rart cT/espkok Tax Parcel Number: 9g9f0000 / Property Size: (acres/square feet)_ Site Address and/or Directions to Property: a2 Al/2 krn i) Cr Or/14YL1r.J 2 ( ?8,X5 Property Owner(s)of Record: � l� Telephone: 43 7-Z1O4S l o)9/—J971{ Fax: email: Mailing Address: 5dlr/F 45 Sl T& Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies!� ❑Lot or Road Segregation ►::uilding F'c�, ,;cv, °K)ft`.1t4C42^x1:14" 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 Facilities)** ❑ Change of Use 0 Boundary Line Adjustment ❑ Address 0 Road Approach 0 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 ❑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 designate to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE 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 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 h r s wants rio ti . x Signature: Date: /d'Ye, The action or action ppli ill unde e as a resu 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 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 res lb'i forted/ .t1 d complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: • /� ,� Date: ;J 1 0 10 le G:\PermitCenter\###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 oft-General Contractor for the proposed project. Signature: i •• Date: J"/d'/D GENERAL CONTRACTOR R MAN •CTURED Ho E INSTALLER: PHONE: Fax: jilQ_V ciu41/0/ (16o)4so2•-aos6 ( ) MAILING ADDRESS: /SS3 7cet giPGuvo 125 PT yiNe ts§ AIL: Ckrsot CONTRACTORS LICENSE WAINS NUMBER: ALA NLLA/Si NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New 0 Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel 0 Concrete To : Height: ❑ Individual Syste Repair ❑ Masonry SEP Permit#(•) i1n /� e El Demolition 'Other: Bedrooms: Water Supply: Existing: /�; Setback: 0 Private well 0 Two Party Type of Heat: Proposed: /�/ 'ublic 1 Tota: / Name of System: t" L- If this is a Commercial Protect 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: 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 Fqr Office Use Only Amount Revision Main Floor Heated EH Bld App Review: O 2"tl Floor Heated Consistency Review: _... Other Heated Base fee: I 36 Mezzanine Additional Section: 0 Heated Basement Plan Check fee: J Unheated Basement State Surcharge fee: ,'( ` Other Unheated Pot Water Review fee: O Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other TOTZL: $ r7 . �— __ 3 — / Receipt Number: I I J(d 3 Cash/Check Number: STIMATED COST(REQUIRED) Date: c Fair market valu of all labor and materials foundation to finish _ �'�� //oao Initials: r G:\PermitCenter\###FO ent DRD Forms\Master Permit Application 5-29-08.doc 'o Z+ n C, 3 6) /3 op,ERV" /x i 6fq.8^ o m 1 4 0 G. 01 E. n 70 y I R '� Cam) rn . m r S Y a / -.v.,. O "' / '° o S ' ' z. v f ` '� m U a. `� 1 - - :� �r y , ro -- z •, : _ 1 1---NN cm m _ _ _ _ __ _ � _ _' rnco-71 r l'41 -16 r- I O - x UN 2 (.„ z � \ rn al 0 Its C Z pT (/) SN of 0 Z -p i /J 0 33 0 m , a m N > Lil - n ‘-' z i\) r s' --------- De Y �w LL 4icg' In— r' Puopft,y Ldn& 711.37