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Home My WebLink AboutBLD2011-00253 SILDING PERMIT APPLICATOR' BRD1 OOp2e53 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD11-00253 Received Date: 9/15/2011 SITE ADDRESS: 82 N PITTSBURG AVE PORT TOWNSEND, 98368 OWNER: LI LI MEI RAIGUEL PHONE: 360-531-0481 200 W KINKAID ST PORT HADLOCK WA 983399660 IRONDALE SUBDIVISION: Block: 123 Lot: 34-40 PARCEL NUMBER: 962112313 Section: 34 Township: 30 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: JAIME KOZELISKY PHONE: (360) 385-3215 1112 S JACOB MILLER RD (360) 385-3215 PORT TOWNSEND WA 98368 PROJECT DESCRIPTIOr RETAINING WALL TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 3,000.00 ADD'L: HEAT TYPE: CODE EDITION: 2009 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 0 Pro : Total: 0 Total: 0 Ro tinq Date: __-------Th — Type Amount Paid By: Date: Receipt: ��p1Qvg�/�es ,�w Permit $83.25 LYK 09/15/11 128128 PI V IID State Building Code $4.50 LYK 09/15/11 128128 Plan Check $49.61 LYK 09/15/11 128128 SEP la 2011 Total: $137.36 Jefferson County Planning &Building Department Jefferson County Building Di sion Permit Num. r: BLD11-00253 BUILDING PERMIT INSPECTION APPROVALS applicable Clodet 2009 Inte national Building To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection. Codes Requests received after 7:00 AM will not be scheduled for that day's inspections. ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries. The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection Inspection Item Date Approval Signature Notes Setbacks MIME FINAL INSPECTION i'6 mum FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR I '91goN t~4 JEFFERSO UNTY ` DEPARTMENT COMMUNITY DEVELOPMENT ip ort 621 Sheridan tree : Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax -;y,S, NG/O www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: �L, ofl( EEG ' Project Description(include separate sheets as necessary): I tiN ST A t" t .1J014►,t.Q t...,4-3 C CO R Loc Ic ae-+k,N ER- c.AJ/FU 2$_L I, cSb i4t6I,- Tax Parcel Number: 96.2. i i 2 2,/3 Property Size: • '"L! 4C 4 (acres/square feet) Site Address and/ 'ections to Property: 87 0 • 1 rr r-r.t , Pof r k Alum L ciciLk Property Owner(s)of Record: Telephone: A-3 j Q y R ) Fax: email: Mailing Address: `/I r'Y0,34-cb , p u al— Al L C k Applicant/Agent(if different from owner): J 4 ,/i Z `LLS e Telephone: Fax: �/� email: Kozl n1Ce •CONS Mailing Address: What kind of Permit?(Check each box that applies .0Building 0 Critical Areas Stewardship Plan ❑ Demolition Permit i- 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 Essenti•al ❑ Change of Use ❑ {? , ti ' ' \--ii ❑ Address 0 Road Approach 0 - `/ I- ❑ Home Business 0 Cottage Industry 0 r'd g- rprn ❑Propane ❑ rag at** ❑ Sign 0 Iced Rural Residential Devel Fri (PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis 0 Iat Vacation/Alteration** ❑Stormwater Management 0 horr#Iine Master Program Ekem ' rmit Revisions** ❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline ag tantial Devis lopment** ❑Temporary Use * ❑ Shoreline Till erne OfrrpggEM O Wireless Telecommunication ❑Compre PI /Cari se DDistrict Map Amendment ❑Forest Practices Act/Release of Six-Year Moratorium 0 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: ✓ r/ k% �' DESIGNATION OF AGENT I hereby designate �(/� }(7 to act as myagent in matters relatingto this application for permit(s). 17 ,v g PP P ( )• OWNER SIGNATURE Cl Q l 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 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 wan prior notice. Signature: Lt i.i- Ito i-i„( Date: / ) — // 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 to and complying with the ESA. The Applicant has read this disclaimerand signs an dates it below. Signature: (St.(„t,�.c_VO +\(il' Date: / " / 3 — U:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc i ! . • • 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 responsibil' of khe General Contractor for the proposed project. Signature: V� , / � GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ( ) S, MAILING ADDRESS: f / , if.N10 _� (3C 3a. - 3 Z? S 3 Ai + c�A-Q 4 e t i F EMAIL: I14aZ I N C 0 /k 4 C o CONTRACTOR'S LICENSE �{ WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: I/_ A f� t` �j a 1 K... .. PHONE (� ��c b t '4X-( ) MAILING ADDRESS: L(!bp I /4 s,f J p r _ EMAILgQctF�-rFCrC._ spa-�BEsr. Nf-r. Project Type: Frame Type: Bathrooms: ❑ New Shoreline: Type of Sewage Disposal: ❑ Wood Existing: 1 Sewer ❑ Addition , ❑ Steel Proposed: Bank CIAlteration/Remodel ❑ Concre To - CI Community m ID Repair _ Height: ❑ Individual System ❑ Masonry SEP Permit# 0 Demolition 0 Other: Bedroom . Existin. Water Supply: Type of Heat: Setback: El Private well 0 Two Party Pro...._.; ❑ Public Total: Name of System: If this is a Commercial Project you must answer the following: Number of Parking Spaces: Current: Proposed: ... .7-1 Number of occupants(includes owners,tenants,employees,etc) Current IBC Occupancy: �—Proposed IBC Type of construction: Wil ve Fool.Scr ?i?fes /If this is a Pro ane Tank and/or A liance Installation rmit mark all items i Underground Tank I t o I . 9Above ground Tank Size of Propane Tan L I I Heat Stove I Cook Stove I Woodstove I Fireplace Insert I Hot Water Tank `�i eiNet-8 Is this appliance being installed in a Manufactured/Mobile Home? Yes / No tabouy RS When applying for a permit to install a propanesosuDEPTmit a si .OF COMMaUNITY thDEVELOPMENT lines, tank location and size,distances from the propane tank to all property lines,buildingsand se tic system coall mponents, property including the reserve area. p y ponents, Square Footage Current Proposed For -4``e.'m' ' Cif! "*§!,�7 ' ' " 7'};;' Main Floor Heated EH BId App Review: .. 2�a Floor Heated Consistency Review: _ Other Heated Base fee: Mezzanine , Additional Section: Heated Basement Plan Check fee: Unheated Basement 4q• 0 State Surcharge fee: /r 0 Other Unheated ¢t Pot Water Review fee: Garage/Carport SUBTOTAL Decks 207 911/Rd Approach fee: Other '�� TOTAL: $ a ,3,10 Receipt Number: I(Dg I al Cash/Check Number: 34, r(� ESTIMATED COST(REQUIRED) `-L"� .Fair ma et value of all labor and materials foundation to finish Date: (]I - 3 act) Co Initials: ------5_____ G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc Z 1-- j Lys o 1 z = (A kb a P w w � 41 z Q {W � c .3 1 2 a Z tu g " 4, 1 ___ t k . \ b (Acid 42 ci -C ', — \ ot- 4t i(N 1.- ,„rrcl Cam• _ , sh. . ....Nit .........._...„ . ,. _ . 8 "� �/' fl ("u€c1 tt ----- ` 1 2 I 1 4--is'\ - _ n t3 (� t ._. il M W4-7 tr R- F--- x 0 J� r_ 4 � N s N k — cu �, c eE - Y U► c i-i M ). , ' . LEI — v a 2 Yko. `v .. 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