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Home My WebLink AboutBLD2012-00132 WILDING PERMIT APPLICA•N BLD12-00132 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD12-00132 Received Date: 4/25/2012 SITE ADDRESS: 303 SNAGSTEAD WAY PORT TOWNSEND, 98368 OWNER: MICHAEL HEMSLEY PHONE: RITA HEMSLEY 303 SNAGSTEAD WAY PORT TOWNSEND WA 98368-9257 SUBDIVISION: Block: Lot: T56+ PARCEL NUMBER: 001292012 Section: 29 Township: 30 N Range: 01 W CONTRACTOR: INTERLOCK INDUSTRIES INC PHONE: 425-438-8585 1420 80TH ST SW SUITE E EVERETT WA 98203 Contractor's License INTER11020LC Expires 2/6/2013 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP RE-ROOF TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 13,497.00 ADD'L: HEAT TYPE CODE EDITION: 2009 HEAT BASE: HEAT TYPE: OCCUPANCY: OCCUPANCY: UNHEATED: #OF STORIES: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $237.25 LYK 04/25/12 131676 Plan Check $154.21 LYK 04/25/12 131676 State Building Code $4.50 LYK 04/25/12 131676 Total: $395.96 Jefferson County Building Dion Permit Nun.: Applicant: BUILDING PERMIT INSPECTION APPROVALS \pplicable Code: International Building Codes To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection. Requests received after 7:00 AM will not be scheduled for that day's inspections. ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries. The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection Inspection Item Date Approval Signature Notes FINAL INSPECTION Sok FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR JEFFERSOWUNTY 0 *eiff;As °1" DEPARTMENT OF COMMUNITY DEVELOPMENT `' '� 621 Sheridan Street • Port Townsend • Washington 98368 lop360/379-4450 • 360/379-4451 Fax p www.co.jefferson.wa.us/commdevelopment '`Y$ING.'' Master Permit Application MLA: kb (YIU\ e 'N Pro ect D scription(include separate sheets as necessary): Tax Parcel Number: t(...)I 2_64.201Z Property Size: (acres/square feet) Site Address and/or Directions to Property: -3.02Th SmnAelc, [-RDe_1- b ty)selAis u-lL qi?)34::;!&3 Property Owner(s)of Record: 4III r ,/ /' / Telephone: Fax: email: Mailing Address: 30 5 -Lo x 4:,._)---- Tr-- W --I 7 ,}2 &4) Applicant/Agent(if different from oJdner): rut-/ &"g /,.%'C 114 L{�r5 7s'r ."S. Telephone: -(_00 7-, h c% Tj �, Fax: email: �e••/L--1 S'US (' j��.l, Mailing Address: /4/ 0 go .4 S/ Cc/ �`e,"P ,L 2 P P�,Z03 ' (�, , What kind of Permit? (Check each box that applies 0 Lot or Road Segregation Building 0 Critical Areas Stewardship Plan i Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family ❑ 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(Essential Public Facilities)** ❑ Change of Use 0 Boundary Line Adjustment ❑ Address _ 0 Road Approach_ 0 Short Plat** ❑ Home Business ❑ Cottage Industry ❑ Binding Site Plan** ❑ Propane 0 Long Plat** ❑ 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)* 0 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 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 v � /�0/,' 7``- to act as my agent in matters relating to this application for permit(s). • 1�f OWNER SIGNATURE! -'4---\_____.-- -1/----- Date: 9 2 S l Z 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 provi access and ght of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any r Air later ins i s. Staffs a ss and right of entry will be assumed unless the applicant informs the County in writing at the time of the ap on tth e he or a ants prior y �.y Signature: `T Date: ( 'G" ( e— 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"Ez.,,eff rson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been iss ill not a ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if y u,afe i comwith the Je n Co y development code.The Applicant acknowledges that he,she or it holds individual and non-transfe e rensib adherin an plying with the ESA. The Applicant has read this isclaimer and signs and dates it below. Signature. i . Date: c�L 5 -0G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\blaster Permit Application 5-29-08.doc II BUILDER STATEMENT 111111 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: �-, le.4.1.4-,c-, i. 1NcA c%e..C_� /�s1�_ (V!Y 113 e2Tr ( ) u3 2 77 MAILING ADDRESS: f"/y2 v f ),1% �"/ _ca/ fi...13K-ell it, ek EMAIL.: CONTRACTORS LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Type of Sewage Disposal: New C Wood Existing: Sewer ❑ Addition E Steel Proposed: Bank C Community System C Alteration/Remodel C Concrete Total: _ - • ❑ Individual System C Repair C Masonry SEP Permit# _ C Demolition C Other: Bedrooms: Water Supply: Existing: •- ❑ Private well C Two Party Type of Heat: Proposed: C Public Total: Name of System: • If this is a Commercial Protect 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: l Underground Tank 1 Above ground Tank Size of Propane Tank: 1 Heat Stove i Ceok Stove I Woodstove i Fireplace Insert i Hot Water Tank 1 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, includin•• the reserve area. Square Footage Current Proposed For Office Use Only Amount Revision FloorMain : . •.. Floor • AdditionalOther Heated Base fee: ()3---f_ 25 Mezzanine Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: 2-1- 9') ' Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Decks Approach fee: i I STINIATED COST(REQUIREDO Date: •Fair market value of all tabaFend ma-terials foundation to finish -25-a--___ - G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc