HomeMy WebLinkAboutBLD2012-00282 •JILDING PERMIT APPLICAT N BLDI2-00282
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD12-00282 Received Date: 9/12/2012
SITE ADDRESS: 71 N PALMER DR
PORT TOWNSEND, 98368
OWNER: KAREN LULL PHONE: 360-379-8118
71 N PALMER DR
PORT TOWNSEND WA 98368-9489
CRESTHAVEN SUBDIVISION
SUBDIVISION: Block: Lot: 9
PARCEL NUMBER: 946100009 Section: 12 Township: 30 N Range: 02 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr EXPAND EXISTING BATHROOM & CONVERT GARAGE TO UNHTD
WORKSHOP, MUD ROOM & LAUNDRY ROOM
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP ALT
VALUATION 6,500.00 MAIN: 12
CODE EDITION: 2009 ADD'L: HEAT TYPE: EEE
OCCUPANCY: R_3 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
CONST TYPE: 5N OTHER:
GARAGE: SHORELINE:
CONST TYPE: SETBACK
DECK:
BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: 2 Exist: 1
Prop: 0 Prop: 0
Total: 2 Total: 1
Routing Date:
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $139.25 LYK 09/12/12 135190 H H H O V E
Plan Check $90.51 LYK 09/12/12 135190
State Building Code $4.50 LYK 09/12/12 135190 SEP 12._ 2012
Total: $234.26 Jefferson County Planning
& Building Department
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Jefferson County Building Division Permit Num.: BLD12-00282
Applicant: LULL
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
Under Floor Framing ID .(Z
Rough-in Plumbing i0 ()--r-
Framing tom _ Z F
Airseal 40-3 6- (2 `
Wallboard Nailing _ Z `
Mechanical Systems
FINAL INSPECTION �L�t_1 i .L
1
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
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_-___,
��`�•SON c0r, JEFFERSON.UNTYIII
W . ' '1� \ DEPARTMENT OF COMMUNITY DEVELOPMENT
`' " ` ''4 621 Sheridan Street • Port Townsend •Washington 98368
itop
360/379-4450 • 360/379-4451 Fax
kq�, N0�0� www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: NO A
roject Description (include separate sheets /as necessary):// — ,59-,z 4 i tck..2,1 i��,���Y 4
&� i Lt-Pid 0, -h �r4 b Ili 'l o Re 'c71'C,tck2-d 4,2 . cf -t ved 1L fi('c._cc '
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Tax Parcel Number: 7Z/� — /C"C� — CC'
Property Size:j 7, /S�, sl, f f (acres/square feet)
Site Address and/or Directions to Property: l
1i �t. �XYy"i c 1�F . `' } jG`Ct ;l. t�i1Cl I V,.0 [!�c �CC Ian C7�cQ �i- C /� tiy)
Property Owner(s)of Record: C;.' r1 )_t.,_ I
Telephone: :3 ]ci- `d I l ct' Fax: email:
Mailing Address: / c\vrl c ��r��, V--C- • 1 c- c,- ,1)e'f)6( V 2 iA `'r : 30 c:
._ Applicant/Agent(if different from owner): •;r,,,,,_,_
Telephone: Fax:
email:
Mailing Address:
W at kind of Permit? (Check each box that applies
i ❑ Lot or Road Segregation
wilding 0 Critical Areas Stewardship Plan
Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use)
❑ Single Family ❑ Garage Attached/Detached 0 Conditional Use[C(a), ii •win
❑ Manufactured Home 0 Modular 0 Discretionary"D"or Un
0 Commercial* 0 Special Use(Essential a • -•`y. sick,
❑ Change of Use 0 BoundaryLine Adjust ^ .
❑ Address 0 Road Approach **
PP ❑ ShortPlat SEP 1 2 2012
❑ Home Business 0 Cottage Industry ❑ BindingSite Plan**
❑ Propane ❑ Long Plat**
❑ Sign ❑ Planned kurai Reside tial : - ••..--• -::. _n-•• - is**
❑Allowed"Yes"Use Consistency Analysis ❑ Plat Vacation/Alteratio *" JEFFERSON COUNTY
0 Stormwater Management 0 Shoreline Master Prog -•• atu'ul,I,J.60MMYttliltIfiteMAINT1p*
0 Site Plan Approval Advance Determination(SPAAD)* ❑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 ❑Tree Vegetation Request
**Requires a Pre-Application Conference
Please identify any other local,state or federal permits required for this proposal, if known:
N1A
DESIGNATION OF AGENT
I hereby designate VA rtvt -/C l‘k. h , to act as my agent in matters relating to this application for permit(s).
j'OWNER SIGNATURE -�./1�/ Date: 1A�/ Z
By signing this pp(' tion form,thoner/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
ti e of the appli 9tfon that he or she v fits prior,notice.
i1 igriature: ' • �� -
Date: `t/// //a-
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-transfer ble responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
ignature: //7U� l�
t�r _t! Date: 7�//7/Z_
t --
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
• S
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 e General Contractor for the proposed project. /
*Signature: Date: — 7/li ! f Z
GENERAL CONTRACTOR 0 NUFACTURED HOME INSTALLER: PHONE: FAx:
( ) ( )
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE ( ) PAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New '52 Wood Existing: E Sewer
G2 Addition ❑ Steel Proposed: ± Bank 1 Community System
Alteration/Remodel C Concrete Total: \ — Height: O Individual System
❑ Repair C Masonry SEP Permit# i.1.—Ooo 15
o Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Z. Setback: LI" Private well C Two Party
T of Heat: Proposed: O ❑ Public ^
ype Total: 7 Name of System:,.7 Cz,;,,v
If this is a Commercial Proiect 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
•
;BC 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 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 Curren Proposed For Office Use Only Amount Revision
Main Floor Heated EH Bid App Review:
1 .w �, _ _ e-Ei/1 ew
21-0 Floor Heated Consistency Review: --____—
Other Heated Base fee:
13) 25
Mezzanine Additional Section:
Heated Basement Plan Check fee: ,-1 • J
Unheated Basement State Surcharge fee: • c (.'
Other Unheated Pot Water Review fee:
Garage/Carport ( f-. SUBTOTAL
Decks 911/Rd Approach fee: ___---
Other TOTAL: $, 3L4
Receipt Number: I�I qv
Cash/Check Number: 3079
ESTIMATED COST(REQUIRED) Date: (� �Z�2
•Fair market value of all laborar� terials foundation to finish I
1650 0 i Initials:
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc