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Home My WebLink AboutBLD2010-00238 BLD10-00238 11113UILDING PERMIT APPLIC N Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD10-00238 Received Date: 7/6/2010 SITE ADDRESS: 341 VERNER AVE PORT LUDLOW, 98365 OWNER: HEATHER A DOSCH PHONE: 360-385-0480 KEVIN M DOSCH 7841 NE 21ST ST MEDINA WA 980392313 OLYMPUS BEACH SUBDIVISION: Block: Lot: 87+ PARCEL NUMBER: 978900093 Section: 4 Township: 28 N Range: 01 E CONTRACTOR: JOHN F BUCHAN CONST INC PHONE: 425-827-2266 2821 NORTHUP WAY BELLEVUE WA 98004 Contractor's License JOHNFBC300PN Expires 7/3/2011 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI` RE-ROOF GARAGE TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 2,155.00 ADD'L: HEAT TYPE: CODE EDITION: 2009 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: Approved/Date Permit $83.25 LYK 07/06/10 117944 Plan Check $54.11 LYK 07/06/10 117944 State Building Code $4.50 LYK 07/06/10 117944 Total: $141.86 Jefferson County Building •sion Permit Nuer: Applicant: EUILDING PERMIT INSPECTION APPROVALS applicable 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 FINAL INSPECTION FINAL NSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR 4.i. 6, JEFFERSO•OUNTY • C u �( ( h DEPARTMENT OF COMMUNITY DEVELOPMENT ,� l� 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 360/379-4451 Fax oe � -- -- ,p'� www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: 1\k LA Project Description(include separate sheets as nets ) '- ? I 1 ,.._ A"--fi (A. Ck'c.A.(0.--k Tax Parcel Number: -t`f 5 Property Size: (acres/square feet) Site Address and/or Directions to Property: `// Very Ate--A L tI/ox, Ilk , qbS'j65r- Property Owner(s)of Record: Telephone: " - L Fax: email: fa. Mailing Address: 3y/ Vet - �, (123 -Li t 1 -J Applicant/Agent(if different from owner): // Telephone: Fax: email: Mailing Address: Wh t kind of iaermit?(Check each box that applies ❑Lot or Road Segregation uilding -`K ci r o a F 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 ❑Short Plat** ❑ Home Business 0 Cottage Industry ❑Binding Site Plan** 0 Propane 0 Long Plat** ❑ Sian 0 Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis 0 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 ❑ 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). 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 y 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 plication th or she ants prior notice. /Signature: Date: 7/6'// ) The action or ctions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered eCies and Could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the "Endangere pecies 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-tr sferable reporsibility r adhering to and complying with the ESA. The Applicant has read this disclai era d signs and dates it below. Signature: Date: 1p�j!7 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 of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ',Yth/F. _/5ueb_d,' W) 27-aalob(0,s-r ,a 7-$�b MAILING ADDRESS: �� ✓ VVQ EMAIL: ,�� r��rj,9,, �J WAINS CONTRACTORS LICENSE / llw LL2? • Roo NUMBER NUMBER: D 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 ❑ Alterati ❑ Additionaion/Remodel CI Concrete Total: Height: CIIndividual System — SEP Permit# ❑ Repair ❑ Masonry ❑ Other: Bedrooms: Water Supply: Demolition Existing: Setback: ❑ Private well ❑ Two Party Typeof 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: 1 Underground Tank 1 Above ground Tank Size of Propane Tank: i Heat Stove i Cook Stove 1 Woodstove i Fireplace Insert i Hot Water Tank i 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 I Current Proposed For Office Use Only Amount Revision Main Floor Heated EH Bld App Review: _ 2"d Floor Heated Consistency Review: Other Heated Base fee: rj.2 r Mezzanine Additional Section: OJ Heated Basement Plan Check fee: y-,j / % Unheated Basement State Surcharge fee: -r) C`! Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL ! `/ J` / Decks 911/Rd Approach fee: , __ 0_- Other TOTAL: $ / / % Receipt Number: (11 q 4 % Cash/Check Number: 5 EST ATED COST(REQUIRED) Date: •Fai market value of all labor and materials foundation to finish Initials: G:\PemutCenter\###FORMS###\DM—FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc 'o 73 O 2 mW n -s z a 3 , m 0 0 N CID I m r .: rn a 0) v v m CP 2) `4(--- P(f, 'Zoe3o cn I L 1 i • t . . v _ --s r m • co r O 1 v > 0„.._ _) CA.-7E re----,--) , v m cn cn si* O z m z c 3 W m 70 -n m 73 z 77 , t___/ iili2, 2