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HomeMy WebLinkAboutBLD2010-00355 MANUFAJRED/MOBILE HOME INST LATION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD10-00355 Received Date: 10/5/2010 SITE ADDRESS: 531 DENNIS BLVD Issue Date: 10/5/2010 PORT TOWNSEND, 98368 APPLICANT: LAURA WELCH SUSAN GARNER/RICKEY WELCH 531 DENNIS BLVD PORT TOWNSEND WA 983689482 SUBDIVISION: CAPE GEORGE VILLAGE DIV 3 Block: Lot: 55 PARCEL#: 940500054 Section: 13 Township: 30 N Range: 02 W CONTRACTOR/ DEALER PROJECT DESCRIPTION: THIS IS NOT A BUILDING PERMIT!!! THIS CASE WAS CREATED FOR TITLE ELIMINATION ONLYH MAKE: KOZY NOT A LIFYeeAFE AEVIEW-SE1 l 20B19660186 Directions To Site: 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 Miscellaneous r )_43-(U F-6 INSPECTION FOR TITLE ELIMINATION FINAL INSPECTION /6 � 7 FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR •UILDING PERMIT APPLICA N B RDA O-00eew ppe55 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD10-00355 Received Date: 10/5/2010 SITE ADDRESS: 531 DENNIS BLVD PORT TOWNSEND, 98368 OWNER: LAURA WELCH PHONE: SUSAN GARNER/RICKEY WELCH 531 DENNIS BLVD PORT TOWNSEND WA 983689482 CAPE GEORGE VILLAGE DIV 3 SUBDIVISION: Block: Lot: 55 PARCEL NUMBER: 940500054 Section: 13 Township: 30 N Range: 02 W CONTRACTOR: PHONE: PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP THIS IS NOT A BUILDING PERMIT!!! THIS CASE WAS CREATED FOR TITLE ELIMINATION ONLYH NOT A LIFE SAFETY REVIEW - SER#WASD5520B19660186 TYPE OF WORK ( SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION MAIN: CODE EDITION: 2009 ADD'L: HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE: 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: Total: Routing Date: Type Amount Paid Bv: Date: Receipt: Approved/Date Permit $71.00 LYK 10/05/10 120159 Total: $71.00 Oct 04 10 07:29p III . p.2 ,i,v--- c06. JEFFERSON COUNTY . ' 1 DEPARTMENT OF COMMUNITY DEVELOPMENT 62 i Sheridan Street• Port Townsend •Washington 98368 360/379-4450• 360/379-445 1 Fax jul.. .),._ www.co.jefferson.wa.uslcommdevelopment Master Permit Application MLA: t30 (IY L,.A efit Project Description,,(include separate sheets as necessary): N '�j� , -1I,e G J• rJr v..ft ,C171 0. tt � riK, Pia vC Ow Tax Parcel Number:9 Oa 1 Property Size: (acres/square feet) Site Address and/or nireclions to Property, 31 )Pon!S 6 -4:--1 Property Ownerls)of Record:_ Telephone:_ ax: emai• Mailing Address: iJ 1t Ls e 1 Z c{ t �f 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 OBui ding ❑Critical Areas Stewardship Plan . O Demolition Permit • 0 Variance(Minor,Major or Reasonable Economic Use) ❑Single Family 0 Garage Attached I Detached 0 Conditional Use[C(a),C(d),or Cl** O Manufactured Home•. .0 Modular - • 0 Discretionary'D"or Unnamed Use Classification O Commercial* 0 Special Use(Essential Public Facilities)** ❑ Change of Use 0 Boundary Line Adjustment ❑ Address 0 Road Approach ©Short Plat** ' 0 Home Business El Cottage Industry 0 Binding Site Plan** 0 Propane 0 Long Plat** 0 Sign • •- '• 0 Planned Rural Residential Development(PRRD)/Amendments"`* 4 ❑Allowed`Yes"Use Consistency Analysis 0 Plat Vacation/Alteration*" o Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions 0 Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development** 0 Temporary Use 0 Shoreline Management Variance O Wireless Telecommunication* 0 Comprehensive PIan/UDCILand Use District Map Amendment ❑Forest Practices Act/Release of Six-Year Moratorium O 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 inferrnation 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 appiqtion that hear she spoor notice. .ac Signature: . ,/...-v i own.n: ' • Dale: i �' /r� The action or actions Applicant will underta 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 lake'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 reganiing 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-trartsff table responsibilit adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. `. Signature: JA%✓ cats- Date:^� at ^"``-'�- �� '�`E 0 •.,,...-:.r......_.4 Lv-'ar,A4d-fi1#\1117r,rune.Or....,,,,.n1)n1:....-.-%1.(....._n.__..■__lc.._.,...C no • • 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: ( ) ( ) MAILING 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 ❑ Wood Existing: ❑ Sewer O Addition ❑ Steel Proposed: Bank 0 Community System ❑ Alteration/Remodel O Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# 0 Demolition ❑ Other: Bedrooms: Water Supp y: Existing: Setback: 0 Private well ❑ Two Party Type of Heat: Proposed: 0 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: 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. i r . c 4 k 3 Y 4.2 F i t " 'v."N L CI w Square Footage Current Proposed . lce §K. s ,;iii t- , .. ,mount,, , r Main Floor Heated ��; , EH Bld App Review: 2nd Floor Heated - Consistency Review: Other Heated i r A ' Base fee: ' .- - Mezzanine Additional Section: Heated Basement �` Plan Check fee: Unheated Basement , . , State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport ` ` SUBTOTAL _ i "' Decks . 911/Rd Approach fee: Otherrwu TOTAL: $ 7/ r Receipt Number: 120 (.5 Cash/Check Number: -7 ESTIMATED COST(REQUIRED) Date: rr-� *Fair market value of all labor and materials foundation to finish V-5-KID Initials: i Ct& tCe-I-1 C9OX 53 See4 (AA s6 :).a:,6 1 9 G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc • So0-14 -00005 1\91-1 9 4o Soo o Sq. Include the following items on your plot plan: o Property boundaries o Wells ❑ Names of adjacent streets ❑ Septic tank o Driveways and parking spaces r6-rainfield(enter NN if unknown)) ❑ Surface water(ponds,creeks,etc) ❑ North Arrow o Buildings(residence.sheds,garages, etc) N I PLOT PLAN-date prepared c '.\ +,n Leffl DRAINFIELP AREA REFER,TO,3ERMIT, It i [�M"jz cis n �--S vbrg- ' N 1 I a5o\ \7�$rC 1 FOI WIl N X9 _ 0^or... CE►�eLH56J) eh 2 G loss ( 2 . GRAvEL 0 ri--) UE ) - 7 C p�N�j Lvp' ENENIIIRaitHECKI Li a, NOT TO SCALE 1612 Hastings Ave.W. ® set. pL,dT F-a- .QC-,rt•i v).-- 9Ard ES Port Townsend, WA 98368 oF ExAg 1-0441ror1 vuK+�w ) � oSa! to £ sT— t o Permit c # ParceI# S o M -7 4-b000 S Page 2 of 4 rn .-1 z • a . 3 Y 1 - .: ..----i ' • H o � .. r 6� 4 • , I t d i • r ',L , m v � I i 1 ; m co , co I I - . i. .. 6' fi ''rtD O lrs r • ; m �� i • --1 r m ' co , i 1 ' r- t . 1 i m I �T'' cn • ! E i Qs �u_ � " '^'. i ' S c J\ • Z ! 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