HomeMy WebLinkAboutBLD2011-00232 PILDING PERMIT APPLICATIR BRLD1ew00p2e32
eviJefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD11-00232 Received Date: 8/17/2011
SITE ADDRESS: 151 DISNEY RD
NORDLAND, 98358
OWNER: ERIC R YOUNG PHONE: 360-385-4859
KIRSTIE A YOUNG
151 DISNEY RD
NORDLAND WA 98358-9535
SUBDIVISION: Block: Lot: T 34+
PARCEL NUMBER: 921094006 Section: 9 Township: 29 N Range: 01 E
CONTRACTOR: DEER RIDGE BUILDERS PHONE: 360-385-9588
76 DEER RIDGE RD
PORT TOWNSEND WA 98368
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP BATHROOM REMODEL - REPLACE FIXTURES, FLOORING, VANITY,
ETC
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP ALT MAIN:
VALUATION 15,000.00 ADD'L: HEAT TYPE: EEE
CODE EDITION: 2009 HEAT BASE: HEAT TYPE: WOD
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: 2 Exist: 2
Prop: 0 Prop: 0
Total: 2 Total: 2
Routing Date:
8--(7--< <
Type Amount Paid By: Date: Receipt: APPROVED
V
Permit $251.25 LYK 08/17/11 128032
Plan Check $163.31 LYK 08/17/11 128032
State Building Code $4.50 LYK 08/17/11 128032 AUG ("7 1U11
Total: $419.06 Jefferson County Planning
&Building Department
� •
Jefferson County Building Division Permit Number: BLD11-00232
Applicant: YOUNG
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
Rough-in Plumbing
Framing � .vs
Airseal L L .( �J�
Insulation:Walls I - 6. ( C (`' -
Insulation: Floors ( _8 ( ��/'3
Mechanical Systems Cit. `I �
FINAL INSPECTION /j 1p _ ( (
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
• S
N 0004. JEFFERSON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
4a 621 Sheridan Street• Po t
$ 360/379�450• 360/37 ��• lam, 1
tITN I e° www.co.jefferson.wa.us/co (ndevefopment I
,�
Master Permit Application AUG 1 7 2011 : 'WO
M P
Project Description(include separate sheets as neggs ):
i3ATtl/Lr c��n i2 L
JEFFERSON COUNTY
Tax Parcel Number. 9ZI —099 — 00OPT.OF COMMUNLDRRPIONAVE L I,137 AC.i2(E (acres/square feet)
Site Address and/or Directions to Property:
t 5 Ro , NOeDt.. rvf3 Z. SS-co
Property Owner(s)of Record: ccQtc Q. YO‘xsIL, fi Kt a, is A. YooN,L:
Telephone: 3 o 3(6 5 59 Fax. email: y('C .o t Y P e"). f ern
Mailing Address: t 5 t 11 5,.0 m (NV,Z rv!) W 'y e 3 s
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
Wqat kind of Permit?(Check each box that applies
gilding ❑Critical Areas Stewardship Plan
LyJ Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use)
IV 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
O Commercial* ❑Special Use(Essential Public Facilities)**
❑ Change of Use 0 Boundary Line Adjustment
O Address 0 Road Approach 0 Short Plat**
❑Home Business ❑Cottage Industry 0 Binding Site Plan**
❑Propane 0 Long Plat**
0 Sign 0 Planned Rural Residential Development(PRRD)/Amendments"*
❑Allowed"Yes'Use Consistency Analysis 0 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* 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 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 attorneys 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 applaTtion he r sheprior notice. /
Signature: ( J Date: ••'I L 11
The action or actions Applicant will undertake as a result of the issuance of this permit may negatively irnpact 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 to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: Date:
G:\PermitCentcr\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc
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