HomeMy WebLinkAboutBLD2010-00248 •UILDING PERMIT APPLICA�N BR vie 00w p24 8
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD10-00248 Received Date: 7/13/2010
SITE ADDRESS: 32 QUEETS PL
PORT TOWNSEND, 98368
OWNER: DONALD J LEE TRUSTEE PHONE: 360-379-4828
CAROLYN J LEE TRUSTEE
32 QUEETS PL
PORT TOWNSEND WA 983689430 CAPE GEORGE COLONY DIV 4
SUBDIVISION: Block: 10 Lot: 34
PARCEL NUMBER: 938701032 Section: 13 Township: 30 N Range: 02 W
CONTRACTOR: ANDERSON RESIDENTIAL INC. PHONE: (206)789-9790
1392 ROSE ST
PORT TOWNSEND WA 98368
Contractor's License ANDERRC984P8 Expires 2/1/2011
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP REPAIR EXISTING DECK & ADD NEW RAILS
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP REP MAIN:
VALUATION 9,600.00 ADD'L: HEAT TYPE:
CODE EDITION: 2009 HEAT BASE: HEAT TYPE:
OCCUPANCY:
OCCUPANCY: UNHEATED: #OF STORIES:
CONST TYPE: OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total:
Routing Date: 6�
'7- i3-t0
Type amount Paid By: Date: Receipt: Approved/Date
Permit $181.25 LYK 07/13/10 117973 APPROVED
Plan Check $117.81 LYK 07/13/10 117973
State Building Code $4.50 LYK 07/13/10 117973 JUL 14 2010
Total: $303.56
Jefferson County Planning
& Building Department
Jefferson County Building •sion Permit Nu•r: BLD10-00248
Applicant: LEE TRUSTEE
BUILDING PERMIT INSPECTION APPROVALS \pplicable Code: 2009 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 /b1'Q
FINAL INSPECTION
FINAL INSPECTIO MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
foiON t, JEFFERSO UNTY c •DEPARTMENT OF COMMUNITY DEVELOPMENT
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'N ''� 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
4.4S, NO4.0 www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: 00 Imcpt £I i.
Project Description Ciclude sep rate sheets as necessary). ,
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Tax Parcel Number: OE 93 ' 7i)f 6.).3 i, Property SiZe: /, 3 5 ) c� ( (acres/square feet)
Site Address} and/or Directions to Property: / '"`�'
.J h a-tee- 6 I�� �^ 1'r"i r/ h11,44i s't d i LG//1 9tfi340 B
Property Owner(s)of Record: Do l.-i arj1 d •j C7A cops yt .1 i-d
Telephone: 36 L!3 7q- .44(c:;*<?t' Fax: email: cJ tee3„-S"F4..+
Mailing Address: �2 (Oa r't'.�,5 POc.0 air-f'T1c'i/, 'Kd z 1.- 9�.� rc e-fe niz i• CUAAA
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
Wh t kind of Permit?(Check each box that applies
A 0 Lot or Road Segregation
uilding c c__ i` � 0 Critical Areas Stewardship Plan
emolition Permit ❑Variance(Minor, Major or Reasonable Economic Use)
❑ Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a), C(d),or C]**
❑ Manufactured Home .❑ Modular . - ❑ 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 0 Binding Site Plan**
0 Propane 0 Long Plat**
❑Sign ❑ 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)* ❑Shoreline Management Substantial Development**
❑Temporary Use 0 Shoreline Management Variance
❑Wireless Telecommunication* ❑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 anrway 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 ter inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the applicatio the or h wa ' r notice.
Signature: t U Date: / .Y/L-)
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 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 areln compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transfers ponsibilit for to and complying with the ESA. The Applicant has read this disclai r and s'gns and dates it below.
Signature: //-. / ,- Date: 7 7.� �/./�l
777
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:
( YI Ct?c'i-9 A tRe,5,do ,...t i 61 Cox 'f>tuc Pi tw , u>r. U4') 385 -33 9y .90 c-,).-a5..---' 6611
MAILING ADDRESS: /j,99'2 /`4 / A r i-fitarH.yri'd EMAIL:
/P.' CONTRACTOR'S LICENSE p WAINS
NUMBER: /9/1,10/::/�i (? ..Vec)Si PS NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
-❑ New 10 Wood Existing: ❑ Sewer
.❑ Addition ❑' Steel Proposed: Bank ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: _ Height: ❑ Individual System
❑ Repair ❑ Masonry SEP Permit#
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Party
Type of 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:
I Underground Tank i Above ground Tank Size of Propane Tank:
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 Use Only _ Amount Revision
Main Floor Heated EH Bld App Review:
2nd Floor Heated Consistency Review:
Other Heated Base fee: I S I (95
Mezzanine Additional Section:
Heated Basement Plan Check fee: ( I S I
Unheated Basement State Surcharge fee: -1 5-)
____ ______
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL - 0 5o
y
Decks 911/Rd Approach fee:
Other TOTAL $`_ '
---� Receipt Number: 11 l-7q-1 3
_. Cash/Check Number1(G3
ESTIMATED COST(REQUIRED) Date: n
•Fair markee of alli for and materials foundation to finish Initials:
__13 -
, (vC/J L
G:\PertnitCent FORMS###\DRD FORMS\Current DRD F s\Master Permit Application 5-29-08.doc
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