Loading...
HomeMy WebLinkAboutBLD2012-00284 ObILDING PERMIT APPLICAION B Review 0284 Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD12-00284 Received Date: 9/13/2012 SITE ADDRESS: 563 PINECREST DR PORT TOWNSEND, 98368 OWNER: JOAN E BARBACOVI PHONE: 360-379-0900 563 PINECREST DR PORT TOWNSEND WA 98368-2510 KALA POINT#7 SUBDIVISION: Block: Lot: 410 PARCEL NUMBER: 965000268 Section: 27 Township: 30 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTION DECK 36 SF ADDITION TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP DEK MAIN: VALUATION 1,200.00 ADD'L: HEAT TYPE: UH CODE EDITION: 2009 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: 36 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 $44.85 LYK 09/13/12 135194 Plan Check $29.15 LYK 09/13/12 135194 w ° State Building Code $4.50 LYK 09/13/12 135194 SEP IS Total: $78.50 Jefferson County Plannint. & Building Department \\firitzmnr4\rhfo\forme\G RI r1 Ann Rid mf 0/1.2i7nV) Jefferson County Building Dion Permit Num ..r: Applicant: BUILDING PERMIT INSPECTION APPROVALS Applicable 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 - fr-10,) 10 3- -/ z, FINAL INSPECTION �; . �. / (c-1-17 FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR 44'�' N caor JEFFERSONOUNTY S re 1 1., DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Part Townsend •Washington 98368 . .7"'" .. . 360/379-4450 . 360/379-4451 Fax '.q p www.co.jefterson.wa.uslcommdevelopment SGS Master Permit Application MLA: no I ' lA Project Description(include separate sheets as necessary): /5-T/A✓*" d i/ g-/ !�e c:� A D,)r r i v.J cm it/,r%t;/C O<.t/eW C_ .0�. ,,&__ Tax Parcel Number: 7(p 5 0 0 b ...'1 Co d Property Size: '�2. A etc, (acres/square feet) Site Address and/or Directions to Property: . .-6,3 P/tire 2 a/zes; - k -Po 2;,b,4,, cc sr,d Cu/A Property Ownerts)of Record: ...TO.4Al E. /,-S i) (21._.-,A,C2)L.J i Telephone:3lc 0. 3-7 y- C 1'Z Fax: email J b ici. 5,cti:�/•W tli;i.ca,,1 Mailing Address: 1 kv) L. �J z. Applicant/Agent(if different from owner): 6trituA Ni 'IZ• 60i._,;C__j.{ (A/LI .Iiar'rl d0 Telephone: -- GC "T)-e— Fax: Wiz- P —— email: Mailing Address: `3ci._. 1/'i,k_ What kind of Permit?(Check each box that applies gtullding 0 Critical Areas Stewardship Plan 0, Demolition Permit 0 Variance(Minor,Major or Reasonable E mi Single Family 0 Garage Attached/Detached 0 Conditional Use ��y(�� C. Manufactured Home 0 Modular 0 Discretionary"D • f idle k ❑ Commercial• C Special Use(Esir{e ❑ Change of Use L3 Boundary Line • tfirtent i i Address El Road Approach 0 Short Plat'• � Ili O Home Business ❑Cottage Industry 0 Binding Site Pla I l't i --I 13 2012 D Propane C Long Plat" j h,.. ,_____/) D Sign 0 Planned Rural sidelntial Dev.inpmant(DPDJ)Amen ents" 0 Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/ eration" JEFFERSON COUNTY { ❑Stormwater Management ❑Shoreline Mast, r ProlpiarrU Gl Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Managed u tantial Development** U Temporary Use G Shoreline Management Variance ❑Wireless Telecommunication• C Comprehensive Plan/UDC/Land Use District Map Amendment ❑Forest Practices Act/Release of Six-Year Moratorium C 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: DES{GNATION OF AGENT I hereby designate �aIZ..A tub R. ?0csc � to act as my agent in matters relating to this application for pormit(s). OWNER SIGNATuRC.i. ^ e. �� A Date: �,/ Z-- C ' Z.- . By signing this appi' ' non 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 attomey'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 appl 'on that he or s wants prior noti . Signature:_ /!' 4.-t--2-t1Y/^ q Date: 1' 42--//2-_._. . The action or/ s 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 actions)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. pate_ , r;:\Yrn n'Ceer\i#gi:oemc## Den yORMS\M2jur Prcir Application 5 29 Ces.J<'c • 411 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. *nature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER _ ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) - MAIL ING ADDRESS: ~ _. EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type ype of Sewage Disposal: Wood Existing: 1 Sewer -- Addition ,' Steel Proposed: Bank 3 Community System Alteration/Remodel Concrete Total: Height: 2 Individual System Repair LT Masonry SEP Permit tl Demolition I Other: Bedrooms: Water Supply: Existing: Setback: i Private well 1 ; Two Party Type of Heat: Proposed: i Public Total: rPrnec'T 111:--I 1E, C� 'If. 1 if this is a Commercial Proiect you must answer the following: 'I ,i I Number of Parking Spaces: Current ed:1'rapas NIutnb@r of AA©A Parking Spaces: Number of occupants(includes owners.tenants,employees,etc) Current , l'. Proposed IBC Occupancy: IBC Type of construction: __. Will ye Food Service? Yes / l If this is a Propane Tank and/or Appliance installation permit,mark all items be4aw I Underground Tank I Above ground Tank Size of Propane Tankt--- qfr 1 F Y FERS ONN CCOOUNNT i Heat Stove I Cook Stove I Woodstove ; Fireplace Insert [ Hot Water Tank --� LOPMENT Is this appliance being installed in a Manufactured l 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 1 Current Proposed For Office Use Only _ Amount Revision Main Floor Heated EH Bld App Review 2"u Floor Heated _,.. ._ Consistency Review I Other Heated Base fee: Mezzanine Additional � Additional Section: Heated Basement Plan Check fee: 2(� 15 Unheated Basement State Surcharge fee: .„4.) SO 7 !1 Other Unheated Pot Water Review fee ' Garage/Carport SUBTOTAL ecks r/ r t (�/ 911/Rd Approach fee: Other TOTAL: $Itg 5 Receipt Number. 1351a4 i I Cash/Check Number et 2..._ ESTIMATED COST(REQUIRED) ( Date:.Fair market value ��value of all tabor and matt�rrals foundation to finish 1 Initials: G:\Permit(: ,tc:'\###FORMS##u\,DKD FURMS\master Pantie Al,I+6cati4?n 5 29 Oa.tux • 0 ..4S.‘%'••... , 1 U())51 --S . \ \,Ni'•.) L___' _______ i , _......-.7.- . ..-.. i..._ ,.--- : . .,.. .._ • _:„. „._. . ! i , v). , f i I 1 .• i I C I • -• -7-i„,-a --r. ,-..-- I ---i-: . 1 1 -Nc) ; . ----7----- -- ---z-.7---2_.& -y 1 I ! ): • SEP 1 3 2012 i_ JEFFERSON COUNTY DEPT,OF COMMUNITY DEVELOPMENT