The URL can be used to link to this page

Home My WebLink AboutBLD2011-00281 1PUILDING PERMIT APPLICA.N BLD11-00281 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD11-00281 Received Date: 10/13/2011 SITE ADDRESS: 234 NEVERGIVEUP RD BRINNON, 98320 OWNER: R THOMAS COYNER PHONE: PRISCILLA A COYNER 14917 256TH AVE SE ISSAQUAH WA 980278333 BRINNON BEACH ESTATES SUBDIVISION: Block: Lot: D PARCEL NUMBER: 936100104 Section: 23 Township: 26 N Range: 02 W CONTRACTOR: TOLLEFSON BUILDERS INC PHONE: (360) 732-4080 TODD HULBERT PO BOX 100 CHIMACUM WA 98325 Contractor's License TOLLEBI977N9 Expires 3/16/2013 REPRESENTATIVE: TOLLEFSON BUILDERS INC PHONE: (360) 732-4080 TODD HULBERT PO BOX 100 PROJECT DESCRIPTIOr STRUCTURAL REPAIR TO ROTTED DECK BOARDS TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP DEK MAIN: VALUATION 18,428.00 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 Bv: Date: Receipt: Approved/Date Permit $307.25 LYK 10/13/11 128241 Plan Check $199.71 LYK 10/13/11 128241 APROED P V State Building Code $4.50 LYK 10/13/11 128241 Total: $511.46 menr OCT �3 2011 Jefferson County Planning & Building Deaart Jefferson County Building Di•ion Permit Numc. r: BLD11-00281 Applicant: COYNER 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 Framing FINAL INSPECTION Z 1,47 FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR 4 °�\ JEFFERSON RUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 1-3 ` '4 621 Sheridan Street • Port Townsend • Washington 98368 al 360/379-4450 • 360/379-4451 Fax k� p� www.co.jefferson.wa.us/commdevelopment kIN Master Permit Application MLA: t\ D MUA Project Description(include separate sheets as necessary): 1 e p,,: - S rrcfc.7 [ r t?o` T W Uv Tax Parcel Number: 4 6, I o o 10 Li Property Size: (acres/square feet) Site Address and/or Directions to Property: Z 3'-( L-k..e.,tee C y� l• Property Owner(s)of Record: `T-‘ r•t,Yh -e-v"' Telephone: Fax: email: Mailing Address: Applicant/Agent(if different from owner): TO dor( (4,)I be-v---- Telephone:3("O c i 2 }Li Fax: emailfWi)c- 'rUle,!`S.;,,,b;.,'t ✓j Mailing Address: eu box (o.' D-.5 '4-'`h What kind of Permit?(Check each box that applies 0 Lot or Road Segregation ilding 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 Uhnameit Usa-C assification-- ❑ Commercial* 0 Special Use(Essential W 1pli F t til * Vr I ❑ Change of Use 0 Boundary Line Adjustrh t L 1 i '. ❑ Address 0 Road Approach_ 0 Short Plat 7, ' ❑ Home Business 0 Cottage Industry 0 Binding Site Plan** i r ' i f ❑ Propane ❑ Long Plat** ; ' O^T j I o Sign • 0 Planned kurai Res' enttal Development(PRRD)/Ame gt)ieints** 0 Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alter tion*'"-- ,I- j ❑ Stormwater Management 0 Shoreline Master ogram,Exe j#f86i)P6rltittfRevisions*"1 ❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Manage lotiyeFtmT 1 ❑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 0 Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference 0 Tree Vegetation Request **Requires a Pre-Application Conference Ptedbe identify any-other local,state or federal penrlitb required fur this pruposdi, if known. DESIGNATION OF AGENT I hereby designate to act as my agent in matters relating to this application for permit(s). OWNER SIGNATU / _.--_ 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 wants prior notice. Signature: 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 disclaimer and signs and dates it below. Signature: Date: G:\PermitCenter\###FORMMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc 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: cid 11�f 1 Zl/- \0- to✓. kI--t r5 ( ) ( ) 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 S:Wood Existing: E Sewer 1 ❑ Addition ❑ Steel Proposed: Bank 0 Community System 0 Alteration/Remodel 0 Concrete Total: Height: ❑ Individual System XI Repair ❑ Masonry SEP Permit# _ D Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well 0 Two Party Type of Heat: Proposed: ❑ 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: 1 Underground Tank i Above ground Tank Size of Propane Tank: i Heat Stove 1 Cook Stove i Woodstove i Fireplace Insert i Hot Water Tank 1 Pellet Stove 1 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. Square Footage [urrent Proposed For Office Use Only Amount Revision Main Floor Heated EH Bld App Review: _. . 2nd Floor Heated Consistency Review: Other Heated Base tee: 77 Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: ,l c Other Unheated Pot Water Review fee: -� Garage/Carport SUBTOTAL I Co Decks / 911/Rd Approach fee: ---- L ice' Other TOTAL: $ 3 t $ , L(c; Receipt Number: (a�' , Cash/Check Number: gq 4,Li ESTIMATED COST(REQUIRED) Date: 'Fair market value of all labor and aterials foundation to finish «_ i 5 f UU 0 Initials: G:\PemutCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc