HomeMy WebLinkAboutBLD2010-00187 •UILDING PERMIT APPLICA•N BL
Revviewiew T Ty187
ype:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD10-00187 Received Date: 6/2/2010
SITE ADDRESS: 290 MUNCIE AVE
QUILCENE, 98376
OWNER: DEUTSCHE BANK NATL TRST CO PHONE:
TSTEE FOR SOUNDVIEW HOME
6591 IRVINE CENTER DR
IRVINE CA 926182118 QUILCENE
SUBDIVISION: Block: 9 Lot: 9-12
PARCEL NUMBER: 991200905 Section: 24 Township: 27 N Range: 02 W
CONTRACTOR: COUNTRYSIDE CONSTRUCTION LLC PHONE: 360-264-4700
4025 SKOOKUMCHUCK RD SE
TENINO WA 98589
Contractor's License COUNTCL99408 Expires 9/28/2010
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION INTERIOR REPAIR - REPLACE ROTTED FRAMING, SHEETROCK,
WALLS, ELECTRICAL & LIGHT FIXTURES
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP REP MAIN:
VALUATION 5,105.00 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 By: Date: Receipt:Permit $125.25 LYK 06/02/10 117786 APPhDoVE r
Plan Check $81.41 LYK 06/02/10 117786
State Building Code $4.50 LYK 06/02/10 117786 JUN 3 201U
Total: $211.16 Jefferson County Planning
&Building Department
Jefferson County Building Oision Permit Nor: BLD10-00187
Applicant: DEUTSCHE BANK NATL TRST CC
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
Framing 6 _ts tO
Airseal (i_t5-1 U
Insulation: Walls -(5_Ib
Wallboard Nailing
Address Posted
FINAL INSPECTION j _,27_ (V
FINAL INSPECTIOr/MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
r4r, oN k0 JEFFERSON•OUNTY •
' ` DEPARTMENT OF COMMUNITY DEVELOPMENT
' 9 ' 621 Sheridan Street• Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
www.co.jefferson.wa.us/commdevelopment
BTN�
Master Permit Application MLA: L.' , (A
Project Description(include separate sheets as necessary):
Tax Parcel Number: (7Q / ?. ()n 9 O S Property Size: S`/J (-00 r� (acres/square feet)
Site Address and/or Directions to Property:
Property Owner(s)of Record: iJ P.„LT s c'.f T_ T.},/ N,>t/ • i/ rA .- (C,
Telephone: Fax: email:
Mailing Address: A , n / .z--.2,, ,-,_, c_ C.e -Tr DR r 4.-P_ -i 2,v r ry, C P Z <: / g
Applicant/Agent(if different from owner): P i e.l S�e% S./a.L " , 1"'
Telephone: 1- 13 E- 1.' z- 3 7 V/9 Fax: /- 9 7 z - 32 `7- 708 7 email:in-,'/., //�/%.�e//%,�
Mailing Address: `/�D/9 /'P-,o. St vcl. , cc.r 'e 7e' j x'2,:,,,,,,, , IN- 7Se 4 _, v7-eL�/,--, Ft? ./,,,,,
What kind of Permit?(Check each box that applies
❑Building El Critical Areas Stewardship Plan
❑ Demolition Permit El Variance(Minor, Major or Reasonable Economic Use)
li'`aingle Family El 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)"
O Change of Use ❑Boundary Line Adjustment
❑ Address 0 Road Approach 0 Short Plat**
❑ Home Business 0 Cottage Industry 0 Binding Site Plan*"
❑Propane 0 Long Plat'"*
❑Sign 0 Planned Rural Residential Development(PRRD)/Amendments**
❑Allowed"Yes"Use Consistency Analysis El Plat Vacation/Alteration"
❑Stormwater Management ❑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 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 attomey'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 applica• that heooshe wants
prior notice.
Signature: i � /- ✓ }_--e-Az = Date: S._/2 7// 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-transferableAesponsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: ( <t,�-T: 7, _./..."---..---,..— Date: i /i V//)
G:\PemvtCenter\###FORMS###\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:
l v Gz"'W1 n / c-I e el 41 i✓ l n,4 , ' i 2-1 C '/ 'u to v i i ( E0) 17 y O-/g j
MAILING ADDRESS: (/$ 5-,-,t� /vh- EMAIL:0(4,V of e h- rr-f M
Ci(%?4W9ii.
( in
CONTRACTOR'S LICENSE rlie /Yva-L-r3) lv� r1` C-32:- WAINS d
NUMBER: l'n c�-..i t C Z. 7 i�'y O g (1--1-- , (2 //S (3�. O
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
I New A'Wood Existing: i i Sewer
'i Addition ❑ Steel Proposed: Bank :J Community System
I Alteration/Remodel ❑ Concrete Total: , Height: P'Individual System
6:t Repair ❑ Masonry SEP Permit#, f, - 00 7
Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: i, Private well ❑ Two Party
Type of Heat: Proposed: ❑ Public
T le c 7-4,,'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:
i 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 For Office Uaednly Amount `Revision
Main Floor Heated EH BId App Review:
4-A p ✓v /.3- ---_-
2"°Floor Heated Consistency Review: ---
Other Heated Base fee: iI5 1 j
c y
Mezzanine Additional Section:
s
Heated Basement Plan Check fee: l • / j i
Unheated Basement State Surcharge fee: .50
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL
Decks 911/Rd Approach fee:
Other TOTAL: $,91 + - I W
Receipt Number: I I 11
Cash/Check Number: T `-�O
ESTIMATED COST(REQUIRED) Date:
.Fair market value of all labor and materials foundation to finish 1
1 J /6-0 Initials: L...__ ,^ _
1 �;�
G:\PemtitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc
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Contact the Buildinp., Department at
d a 0) - 379-4450 prior to making changes
or revisions to the approved plans. LITDFRM-GRIDPAD 0608
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