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Home My WebLink AboutBLD2011-00298 iri_ ON c JEFFERSON OIJNTY • DEPARTMENT Ot- COMMUNITY DEVELOPMENTI i, ` 4 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax . p� BINp www.co.jefferson.wa.us/commdevelopment ` Master Permit Application MLA: tQ InCA Q 'IN Project Description(include separate sheets as necessary): 1 Le tvc. f V ,. t1,c,... .,t; }u kc;..1-<<< Y``.cL iv. 5C.._SC I J 16 �jC Tax Parcel Number: b ,( / 16 3S cO► Property Size: 4O Acr p (acres/square feet) Siteit Address a /or Directions Property: te d1(1W Property Owner(s)of Record: C_e-- Telephone: AOC° ` 19- 7(O 3 Fax: 2--6Co 52/5 e 81r1 email: MAC .3±rgifQt ;I ,(ph Mailing Address: `i7a5"- 3?A-`' Se0.-{i-le. W III 41c105 Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit? (Check each box that applies 0 Lot or Road Segregation Building 0 Critical Areas Stewardship Plan ❑ Demolition Permit 0 Variance(Minor,rMajor rxu� sp ❑ Single Family El Garage Attached/Detached 0 Conditional Use[C(a), '>[C? �3 '--\\ ❑ Manufactured Home .0 Modular • 0 Discretionary"D"or one sift I ' ❑ Commercial* 0 Special Use(EsSentiai Public Facilities)** I ❑ Change of Use ❑ Boundary Line Adjustment I I ❑ Address 0 Road Approach_ 0 Short Plat** i j ! ❑ Home Business 0 Cottage Industry 0 Binding Site Plait** ❑ Propane 0 Long Plat** I `` "i t ❑ Sign 0 Planned Rural Residential Deiiieloiiirj i 'e2RDWAmendments** ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Altleratiop r_0r ('r "!'I,!TY.IT`'r_'!1PM,•''`' --- ❑ 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 0 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 Ptedbe identify any vtfteriocalr state-orfederat-per(tab retiuired fur this , i ,---- DESIGNATION OF AGENT I hereby designat to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: 064' c;)7, o20/1 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 inspection Staffs a ss and right of entry will be assumed unless the applicant informs the County in writing at the time of the application that n pri . Signature: Date: /�j` c: ap The action or actions Applicant will undertake as 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 respo a e. t nd complying with the ESA. The Applicant has read this disc mer d signs and/ o� adate it below. .Signature: Date: � /5l� G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc r Jefferson County Building Diion Permit Num r: BLD11-00298 Applicant: MACE BUILDING PERMIT INSPECTION APPROVALS \pplicable 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 Mechanical Systems V/ / , f rp f"5 0, - ,0.ll /,_7 T> �',C� f/n l� - 45 1/ %'� ; FINAL INSPECTION , 1 4, 11., 2_,._ FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR • • sl;c14 1 x,, ( -- -3068( / - Er I ,.----___..A..,__%•\\;,\\4x6,,, 11, ) Z \t \ \i‘ ,,7 ) t1411\.% \ - IVO A \ -:'oVhk o , N -C� l a�c�d � o m N o ❑ 0 to S J D c- m C. --Er . ' i -1, ,s Z. �� n gSJO ( �� g g c o 0 g i 0 p 1 C C CO �tZ ., 0 w i40 2 4 i")-- ,.., P c) ...• K. 5 r ta\\ ItTlO - cu �. ?arn ) mC O CI p �, � o P Z • OfluL NI ,�-� .C�� . !'J O y °) m o � rD- z a SCSJ / ,� L1J th el, o '. 0 —I s r.� rON � 6Z ) oo Its o .,• 1.4 r*i v t� O — p n ,-. O (� \jAhh: (') PI NON O S IT m i -+ C P W p n - JEFFER�ON COU ITV ,'� • o -, N OEPT.OE CO' 1l4AXllkL�LL,,,E. _ c o pzi mO C) , tD (To -i � cr a C_. 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