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HomeMy WebLinkAboutBLD2010-00331 WILDING PERMIT APPLICA•N BL 331 Rev iewiew T Tyype: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD10-00331 Received Date: 9/14/2010 SITE ADDRESS: 12 QUEETS PL PORT TOWNSEND, 98368 OWNER: BARBARA BARNHART PHONE: 360-379-5735 12 QUEETS PL PORT TOWNSEND WA 98368-9430 CAPE GEORGE COLONY DIV 4 SUBDIVISION: Block: 10 Lot: 35 PARCEL NUMBER: 938701033 Section: 13 Township: 30 N Range: 02 W CONTRACTOR: KITCHEN & BATH STUDIO PHONE: (360) 385-3443 SHELLY 2009 RTH ST, STE B PORT TOWNSEND WA 98368 Contractor's License KITCHBS945ND Expires 8/23/2012 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION REMODEL EXISTING BATHROOM TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP ALT MAIN: VALUATION 16,000.00 ADD'L: HEAT TYPE: EEE CODE EDITION: 2009 HEAT BASE: HEAT TYPE: OCCUPANCY: R-3 UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: 5N GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: PUD BEDROOMS: BATHROOMS: Exist: 2 Exist: 3 Prop: 0 Prop: 0 Total: 2 Total: 3 F.Qutinp Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $265.25 LYK 09/14/10 120085 APPROVEP Plan Check $172.41 LYK 09/14/10 120085 State Building Code $4.50 LYK 09/14/10 120085 SEP 2 I /01U Total: $442.16 Jefferson County Planninc &Building Department Jefferson County Building Desion Permit Null,. BLD10-00331 Applicant: BARNHART BUILDING PERMIT INSPECTION APPROVALS applicable 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 Underground Plumbing Rough-in Plumbing Pressure Test r i -Id .(� �.[ i / - I C- FINAL INSPECTION / /7/9/ FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR I• 1 1 (.1. S ' I : -0 tl a !' , ,I, Lit''l % cso ..-_-_. vil K 6%,„,' 1 g 0 , , , i,.,, ici • L., , , , , . c• , NO (1-- „„ , , 1 i -- NN/ • • , . . 0 ,-5'6 e `\ i, 1 Sz I - i i I ' l \ �X i I , _ . _ ___,. ( .. 0 1 BD 4 Q. 0 N I �► I �, `��.. k:',T1 i V .-i"--- - -3 l s, jL - r N 9 e r / Ic*' , / 54"1 1 35" 4I , L ' \1 \ 66"1113 LNG1N / 267,ii54" , 2' _ Q O«-• No 1-1 ---y "' s'\,4.I 1_ r . c:Cri ) (.7c f—21"— i i t Cl1C3'' N ! i :.,„..._ , \---." \ 1 -Q L� w V, \ 7 /1 1 J N / \ - I HIf l \ I O o T N / di"" I/I 33„ f ink / 0 • o JEFFERSON COUNTY i ' DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend • Washington 98368 l'i � 360/379-4450 • 360/379-4451 Fax www.co.jefferson.wa.us/commdevelopment `� (43 BING Master Permit Application MLA: No (Y A ea) ,h ct Description1 (inclu separate sheets necessary):t� l o c i eVJ Z IJ _ ai-+I i( Tax Parcel Number: q 3 %''©3 3 Property Size: (acres/square feet) Site Address and/or Directions to Property: i�' 2 �cleet3 Fillet C�ipe Gror�tG�loh y) JOrt i ew41Uel 1fh4`f� 3E e Property Owner(s)of Record: ,{3(-),r l at Ael en Lrd rt ,-- Telephone: .3 Go ._ 6 "6'1-.3 ) Fax: email: bei r/3 hi en 4.,,-tL rcc,r e.trr,c:i i,chi, Mailing Address: 12 4uic(3 i k,ce_ p,rt Yoe:if ►vril itvf Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies ❑Lot or Road Segregation li Building 0 Critical Areas Stewardship Plan a' Demolition 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 0 Modular • - - 0 Discretionary"D"or Unnamed Use Classification j 0 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** O 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** 0 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 ❑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 re uired later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the appli tion t at he or shwants pn ot / Signature: • z2t J/VLtt ,x ejits. r no .- Date: 41'4 3//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 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-transferable responsibility for adhering t99 and complying with the ESA. The Applicant has read this discla ner/and signs and dates it below. /Signature: 0)1,)/r k4—� s Yi,.Gi4"L t Date: `(// 3/i° III • 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: GENE L CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: Fax: t 'kJ n i 3i1 Sh, i 7 ( ) ( ) MAI G 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 SWood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System 4' Alteration/Remodel ❑ Concrete Total: , _ Height: Individuat System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: 2 Setback: ❑ Private well ❑ Two Party Type of Heat Proposed: 12(Public El&effi ^ 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 Installationpermit,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 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 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. 4,-, Square Footage Current Proposed ;fir Office Use 4 : ,.: 4 . r,,,,,,,,4k fount, Revision Main Floor Heated a EH Bld App Review: ` ^3— 2n°Floor Heated R'_ Consistency Review: Other Heated Base fee: / ,, 25 Mezzanine Additional Section: Heated Basement 50 Plan Check fee: T. Gii Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: E n f. Garage/Carport SUBTOTAL '^ Decks 911/Rd Approach fee: b'sTI► ISI Other TOTAL: $515 'Co Receipt Number: g 7 )[g,3 Cash/Check Number: ESTIMATED COST(REQUIRED) Date: •Fair market value of all labor and materials foundation to finish l!fraDD Initials: e