HomeMy WebLinkAboutBLD2010-00422 •UILDING PERMIT APPLICAIT)N B RDA ONOyppe22
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD10-00422 Received Date: 12/29/2010
SITE ADDRESS: 741 RHODODENDRON RD
QUILCENE, 98376
OWNER: MACKENZIE DESHLER TAD PHONE: 360-271-3161
CYNTHIA MACKENZIE DESHLER
533 NE 90TH ST
SEATTLE WA 981152956
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 601031005 Section: 3 Township: 26 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: RICHARD BERG ARCHITECTS PHONE: 360-379-8090
719 TAYLOR ST (360) 379-8324
PORT TOWNSEND WA 98368
PROJECT DESCRIPTIOr ENCLOSE EXISTING CARPORT TO BEDROOM
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP ALT MAIN: 357
VALUATION 35,325.00 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:
BEDROOMS: BATHROOMS:
Exist: 2 Exist: 2
Prop: 1 Prop: 0
Total: 3 Total: 2
Routing Date: L
Type Amount Paid Bv: Date: Receipt: Approved/Date
Permit $502.35 LYK 12/29/10 120372 APPROVED
Plan Check $326.53 LYK 12/29/10 120372
State Building Code $4.50 LYK 12/29/10 120372
Total: $833.38 Jefferson County Planning
& Building Department
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Jefferson County Building Division Permit Num. BLD10-00422
Applicant: MACKENZIE DESHLER TAD
BUILDING PERMIT INSPECTION APPROVALS applicable Code: 2009 International Building Codes
To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection.
Requests received after 7:00 AM will not be scheduled for that day's inspections.
ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries.
The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection
Inspection Item Date Approval Signature Notes
Under Floor Framing ate— �`
Framing 2-i -1‘, .
Insulation:Walls
Insulation: Floors
Insulation: Ceiling . tl—t ((
Wallboard Nailing
FINAL INSPECTION FINAL Itv\ilk
„PECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
•
CONDITIONS for Building Permit# :BLD10-00422
1.) No plumbing has been reviewed or approved for this project by Jefferson County Public
Health. Additional requirements may apply if plumbing is proposed.
,SON
A•4i JEFFERSOODUNTY •
4- \ DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street• Port Townsend •Washington 98368
� � 360/379-4450 • 360/379-4451 Fax
www.co.jefferson.wa.us/commdevelopment
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Master Permit Application MLA: I ) `l�P1- C '/ 1)
Project Description(include separate sheets as necessary):
ENC OS C bk'/St/N&' cA/ /WQ'r 4 cow year 77' Ira SPA-4 E. Add L
Tax Parcel Number: d o/ D 3' 0 'S Property Size: 5 6 C/2/ 7 g/$ $`(r ecres/square feet)
Site Address and/or Directions to Property: 72/ e lib 00 D eAl DPO AJ bRiV e. le-ey GO'e POR
(OFP Ca7L6 R0, ,•cgoc5 ?2oK i#7 SECT7iA w/mvRAJPyKn/eP.
Property Owner(s)of Record: "TAD SO La X.
Telephone: 204, -77e - ?Z74$ Fax: email:
Mailing Address: 53'.5 NE go-rift sst% se4-rnc, 14/4 98 i/S
Applicant/Agent(if different from owner):
Telephone' .—._ Fax: email: —_---
Mailing Address:
What kind of Permit?(Check each box that applies
Building ❑ Critical Areas Stewardship Plan
❑ Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use)
tlf Single Family ❑Garage Attached/Detached ❑Conditional Use[C(a),C(d),or C]**
❑ Manufactured Home 0 Modular ❑ Discretionary"D"or Unnamed Use Classification
❑ Commercial* ❑Special Use(Essential Public Facilities)*"
❑ Change of Use 0 Boundary Line Adjustment
❑ Address 0 Road Approach ❑Short Plat**
D Home Business ❑Cottage Industry ❑Binding Site Plan'"
❑Propane ❑Long Plat**
❑Sign ❑Planned Rural Residential Development(PRRDWAmendments"*
❑Allowed`Yes"Use Consistency Analysis ❑Plat Vacation/Alteration*"
❑Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions**
❑Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Substantial Development'"
❑Temporary Use ❑Shoreline Management Variance
❑Wireless Telecommunication* ❑ 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 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 g/CL o to act as my agent in matters relating to this application for permit(s).
`; Date: ( • f -` ♦ /�/
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 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 acces nd right of entry will be assumed unless the applicant informs the County in writing at the
time of the application t e or sh want r noti
Signature: Date: /G2, r2 3 /0
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 re sibility for adh i g to a plying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: / Date: l • -3 /L:
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application S-29-OS.doc
• BUILDER STATEMENT •
The signer of this statement does hereby certify that the re the Owners of the parcel referenced herein,that they are not licensed contractors and that
they will be assum' the resp nsibility a Gene I o tractor for the proposed project.
Signature: Date: 7 �, 10
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
( ) ( )
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WA1NS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: ' /i Shoreline: Type of Sewage Disposal:
❑ New X Wood Existing: Z i 1 Sewer
❑ Addition ❑ Steel Proposed: Bank n Community System
Alteration/Remodel ❑ Concrete Total: Height: X Individual Systeme
u Repair ❑ Masonry SEP Permit# a ct•/ 9
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: 2 Setback: ri Private well H Two Party
Type of Heat: Proposed: % Public
ecec etc- Total: tame of ystem:
VAI3o1� to z ysfP"
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 U• nderground 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 I Mobile Home? Yes I 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,
r ,.
I,t
Square Footage _ Current Proposed LL _ { Amount ;4-Revision
Main Floor Heated EH BId App Review: `
672. $51 _ n I-
2"d Floor Heated ?2.
s Consistency Review:
Other Heated I `;-
x
Base fee: �'03 3c
Mezzanine - _ Additional Section:
Heated Basement 4 Plan Check fee: / . 3
-52Co5
Unheated Basement State Surcharge fee:
Other Unheated r Pot Water Review fee:
Garage/Carport 351 d SUBTOTAL 1 /(9 6�
Decks E� 911/Rd Approach fee:
Otherck.� 771
/STORNIO
Y Sd TOTAL: $ qi
Receipt Number: ( 2 O2
} Cash/Check Number:
ESTIMATED COST(REQUIRED) Date:
'Fair market tie of all labor and materials foundation to finish ?9— _
411 35i 06O Initials:
t_
G:\PermitCenter\###FORMS#tt#\DRD FORMS\Master Permit Application 5-29-08.doc
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Q U I LC E N E WA 983 76 INFORMATION 719 TAYLOR STREET (360)379-8090 N
PORT TOWNSEND,WA 98368 O