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Home My WebLink AboutBLD2010-00375 BLD10-00375 illUILDING PERMIT APPLICAN Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD10-00375 Received Date: 11/1/2010 SITE ADDRESS: 113 CENTER VALLEY CHIMACUM, 98325 OWNER: JOANNA G ENGLAND PHONE: 2481 ANDERSON LAKE RD CHIMACUM WA 983259795 CLARK'S 1ST TO CHIMACUM SUBDIVISION: Block: 2 Lot: 1+ PARCEL NUMBER: 943800203 Section: 14 Township: 29 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: JASON BLEDSOE PHONE: 360-301-9765 CHRISTEL BLEDSOE 113 CENTER RD PROJECT DESCRIPTION RE-ROOF, CEDAR TO COMPOSITE TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 7,074.00 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: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $153.25 LYK 11/01/10 120241 Plan Check $99.61 LYK 11/01/10 120241 State Building Code $4.50 LYK 11/01/10 120241 Total: $257.36 Jefferson County Building DTsion Permit Nurir: Applicant: BUILDING 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 (,ltQ.1) FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR (70 eill cowJEFFERSON COUN ••444�1 DEPARTMENT OF COMMUNITY DEVELOPMENT , ' , in 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax Sys, O0. www.co.jefferson.wa.us/commdevelopment Master Permit Application �t-�,rl MLA: /u b 'Y 1( iZI 1\ Project Description(include separate sheets as necessary): � r -'-d C ercv-�ctg A-� ( ; -cc:1' c-,f•c e )ost 120caf oec.v-nLx. Oct pc›. sic(7.hi ns 2c sA«—Ati"2_<'`Q_Go F 6/4aw,i►-►chi r Sh/v / r Tax Parcel Number: 9y.3 --,Yo0._,2O3 Property Size: fr 3 Ac AK (acres/square feet) Site Address and/or Directions to Property: //3 C,evsk.r oz . CAI 1.mcrcowl Property Owner(s)of Record: Jr,,snvx+C.hrf.sTc./ 8/-c_r) .P, Telephone: (3 6(3') 3 o I- }G Fax: email: c 6Y►r,ins sc c„n cnek, Yc.hoc• ._ M Mailing Address: i/3 Cc.n i..ii- rtni C.A. ivst-Mm W A Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: at kind of Permit?(Check each box that applies ❑Lot or Road Segregation uilding 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 0 Binding Site Plan** ❑ 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** ❑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 f_. /0 - 2 S Date: /C 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 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 application that he or.,she wants prior notice. Signature: ��-�� Date: /0 ,•';---/C 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 responsibilit for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. i Signature: Date: /Q 5—/p G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc Is 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. Date: 76 ot� ^JO /Signature: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: • ( ) ( ) EMAIL: MAILING ADDRESS: WAINS CONTRACTOR'S LICENSE NUMBER NUMBER: PHONE ( ) FAX:( ) ARCHITECT/ENGINEER: EMAIL MAILING ADDRESS: Shoreline: Type of Sewage Disposal: Project Type: Frame Type: Bathrooms: B Sewer 2Wood Existing: / ❑ Adw Proposed: Bank ❑ Community System DI Addition ❑ Steel Height:❑ Concrete Total: _ Hei 9 0 Individual System ❑ Alteration/Remodel Masonry SEP Permit# j0 Repair 0 Bedrooms: Water Supply: Demolition DI Other: Existing: Setback: ❑ Private well ❑ Two Party Proposed: B Public Type of Heat: Total: Name of System: • tJc /�l<c�r-c.— If this is a Commercial Project you must answer the following: Number of ADA Parking Spaces: Spaces: Current: Proposed: Number of Parking Pro osed Number of occupants(includes owners,tenants,employees,etc) Current Will you have Food ervice? Yes / No IBC Occupancy: IBC Type of construction: 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: 1 Heat Stove i Cook Stove i Woodstove i Fireplace Insert i Hot Water Tank i Pellet Stove i Other Is tf___,As_APpjk.nce bein installed in a Manufactured I 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 propane lines,tank location and size,distances from the ro ane tank to all property lines,buildings and septic system components, including the reserve area. Current Pro•osed Fqr Office Use Only = - Amount Revision Square Footage EH Bld App Review: — Main Floor Heated `a Floor Heated Consistency Review: __ Base fee: t3 Other Heated Additional Section: __-_— Mezzanine Heated Basement Plan Check fee: Gq w Unheated Basement State Surcharge fee: 50 Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL 911/Rd Approach fee: Decks Other TOTAL $351, Receipt Number: 12dZU Cash/Check Number: l_ ( ESTIMATED COST(R UIRED) Date: — -- �— - wairlliadoid abor and materia1 ound tion to Iinsh Jo� Z Initials: L.)% : of `, 0 , G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Apphcation 5-29-08.doc o _] c. m _ Z --t z 3 , CENTri. ,Vti 11 Ey D. rn I-- - /09 r 1 a n a� I - m ) u., .,, ! f. 4 _ 0 ' ' • , s ma A L n srn 'v c to y z o W m P 11, v `I in A (^ N'),°d ''' -" i --f-- ' • I _ v K� I . ,_ I ir1 �` p� m m -- M R1 )c Z --►- r I0/ t y o Xs R, c D I P. i X m Cn m r z' r"ca m 0\ m Cl)73 , r � s .0 ,._ m 9 -fl S z 1 y z i o • t