HomeMy WebLinkAboutBLD2012-00003 •UILDING PERMIT APPLICK C BL v
Reviewiew T Ty003
ype:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD12-00003 Received Date: 1/3/2012
SITE ADDRESS: 31 S BAY WAY
PORT LUDLOW, 98365
OWNER: DEAN C YOUNG TRUSTEE PHONE: 360-437-9369
JOANNE V YOUNG TRUSTEE
101 MONTGOMERY CT
PORT LUDLOW WA 983659642 OAK BAY WATERFRONT TRACTS
SUBDIVISION: Block: Lot: 44+
PARCEL NUMBER: 976800025 Section: 29 Township: 29 N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr COU FROM SFR TO SATELLITE BEDROOM -320 SF
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP COU MAIN:
VALUATION ADD'L: HEAT WOD
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: ALT
WATER SYSTEM: 1 PWELL
BEDROOMS: BATHROOMS:
Exist: 1 Exist: 1
Prop: 0 Prop: 0
Total: 1 tat: 1
Routing Date:
Type Amount Pail— l3v: Date: Receipt: Approved/Date
Change of Use or $444.00 LYK 01/03/12 131342 APPROVr'State Building Code $4.50 LYK 01/03/12 131342
Total: $448.50 JAM 3o 2U12
Jefferson County Planning
&Building Department
Jefferson County Building Dion Permit NumT BLD12-00003
Applicant: YOUNG TRUSTEE
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
Address Posted
etrnA l �L(ic_ 1fl r�a�
FINAL INSPECTION —dq,13 fj(
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
•
CONDITIONS for Building Permit# :BLD12-00003
1.) THE EXISTING KITCHEN MUST BE REMOVED AND CONVERTED TO A BEDROOM /
SLEEPING ROOM SPACE. The sink only may remain.
INSPECTION BY BUILDING INSPECTOR REQUIRED PRIOR TO FINAL
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w4�,�,SO.N cb JEFFERSOIWUNTY
' 1j DEPARTMENT OF COMMUNITY DEVELOPMENT _
1' ` '4 621 Sheridan Street • Port Townsend • Washington 98368
360/379-4450 • 360/379-4451 Fax
tgsp www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: I _4
Project Description(include separate sheets as necessary):
Ctrir
\X--- Fic -ks bs1 1 4-0Tax Parcel Number: Q
l l a,pOc:9- Prope Y • e: v(� F a V F {—tres/square feet)
Site Address and/or Directions to Property: I' t
it >
PI, 4 -4._ Pi', , •
Property Owner(s)of Rethrd: t�i2+`t t` you r7 n '' cu J2
Telephone: ,� ,7 Li L / ✓ J
p J 66 7, J ,3,lam j Fax: I Pmatl• �,!`''
Mailing Address: !of V7lew&e ;i )�-`/ t�i?c['Y'"7 I L'" -Y` u_0 r�,,,� F CO 74
Applicant/Agent(if different from owner):
/ I I. t iL IhD_v.
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies 0 Lot or Road Segregation
Building ❑ Critical Areas Stewardship Plan
O Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use)
JiT Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a), C(d),or Cl**
O Manufactured Home .0 Modular - 0 Discretionary"D"or Unnamed Use Classification
0 Commercial* 0 Special Use(Essential Public Facilities)**
O Change of Use ❑ Boundary Line Adjustment
O Address 0 Road Approach 0 Short Plat**
❑ Home Business ❑ Cottage Industry 0 Binding Site Plan**
O Propane ❑ Long Plat**
•
0 sign 0 Planned Rural Residential Development(PRRD)/Amendments**
❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration**
❑ Stormwater Management ❑ Shoreline Master Program Exemption/Permit Revisions**
❑ Site Plan Approval Advance Determination (SPAAD)* 0 Shoreline Management Substantial Development**
❑Temporary Use ❑ 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
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 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 h or she w is prior notice.
ignatu .t7,1 c ci- ' Date: 4,9c..v\ 2 6 12_
The action or actions Applicant will ertake as esult of the i uance of this pe it may gatively impac pon one or more threatened or
endangered species and could lead 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 responsi ility fo adhering to and complying with the ESA. T e Applicant has read this s laimer and signs and dates it below.
Signature: o I 0/
/\ g / Date: ��LN
G:\PermitCenter\###FORMS###\D FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
iBUILDER 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 wi be assuming the responsi ility of he General Contractor for the proposed project.
\\LL eJ
>oignatu Coate: \ L / �7 �/-
GENERAL CONTRACTOR OR MANUFA URED H INSTALLER: PHONE: FAX:
i ( ) ( )
MAILING ADDRESS: EMAIL.:
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: ,Fr,,ame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
G New Wood Existing: 1 0 Sewer
C Addition 0 Steel Proposed: Bank 0 Community System
C Alteration/Remodel C Concrete Total: 1 _ _/Height:, --A IndividualSystem C�
0 Repair C Masonry SEP Permit# F4 "/7 3
L Demolition 0 Other: Bedrooms: Water Supply:
Existing: Setback: \g Private well 0 Two Party
Type of Het: Proposed: l / 0 Public
�OoC' Total: 3C� 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:
i Underground Tank I Above ground Tank Size of Propane Tank:
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/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 Current Proposed For Office Use Only Amount Revision
Main Floor Heated 3..2a EH BId App Review: S
w\ t—.}
2�Floor Heated Consistency Review: -
Other Heated Base fee: /I
Mezzanine Additional Section:
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee: 21 Q
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL
Decks 911/Rd Approach fee:
Other TOTAL: $4 L.(g.sb
Receipt Number: 13 t3t2
Cash/Check Number: (40 3
ESTIMATED COST(REQUIRED) Date: ,,'7
.Fair market value of all labor and materials foundation to finish __• —
Initials: �J j_�
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
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