HomeMy WebLinkAboutBLD2012-00313 BUILDING PERMIT APPLICA1N MLAI2-00218
Review Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD12-00313 Received Date: 10/4/2012
SITE ADDRESS: 51 MARGARET ST
PORT HADLOCK, 98339
OWNER: CHRISTOPHE W FERENZ PHONE: 360-385-2305
LISA MARIE FERENZ
PO BOX 813
PORT HADLOCK WA 98339-0813 CHALMER'S 2ND ADDITION
SUBDIVISION: Block: 30 Lot: 14+
PARCEL NUMBER: 942903004 Section: 3 Township: 29 N Range: 01 W
CONTRACTOR: BUY RITE HOMES PHONE: (360) 681-0777
259403 HWY 101
SEQUIM WA 98382
Contractor's License BUYRIH*0840B Expires 5/20/2014
REPRESENTATIVE: BUY-RITE HOMES PHONE: (360) 681-0777
BIRDIE (360) 681-0780
259403 HWY 101
PROJECT DESCRIPTIOI M/H
TYPE OF WORK MOB SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 1,296
VALUATION ADD'L: HEAT TYPE: EEE
CODE EDITION: 2009 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: 18 SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM: 05783
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 2 Prop: 2
Total: 2 Total: 2
Routing Date:
Type Amount Paid Bv: Date: Receipt: Approved/Date
Manufactured Homes $222.00 LYK 10/04/12 135276
Potable Water Application $64.00 LYK 10/04/12 135276
Total: $286.00
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!• - ,t ' DEPARTMENT• COMMUNITY DEVELOPMENT
i 621 Sheridan t• Port Townsend •Washington 98368 •
Y,4 .— - ; ,-_ 360/379-4450 • 3601379-4451 Fax
www.cojefferson.wa.us/commdevelopment
Master Permit Application MLA: 1 2'2 b
Project Description(include separate sheets as necessary):
/./1, -;72-i17, , 'C 1! //i/'t'f. Ii -)r :' i rs /' :_/ //1 fiic
Tax Parcel Property
Number: t -/1 zj(',y�(.( //' Size: . (acres/square feet)
Site Address and/or Directions to Property:
/ /) F1• 't/t -•! j- 71 f L/ / ,c'r" ,rrLx/l :'t' c% ,/ /itA
Property Owner(s)of Record: ('ff,(7/5/e/)//G,e v t-/ ;r-i i e-_A i
Telephone: %G-( • -,:,')A,_J -Z.. --xi' . Fax: email:
Mailing Address: f,(. . riG''%ti ( / .� `ti 7 tl/i:)!�� ,l.' A. /-/ �(!-.
Applicant/Agent(if different from owner): /`'A.,/ , ,27= ./Cgii :; —(Bird;e")
.y
Telephone: r6 ( -&t_ 1- ( i'% % Fax: G (, - ./,.;L.- / yC. (6:C email:
Mailing Address: 2`;`I (-/L` '� f 1lt't/ il` 1 S a( i f, i /L fi 'VA'�;f l
What kind of Permit?(Check each box that applies � ��
Building ❑Variance(Minor, M j; f n c
❑ Demolition Permit 0 Conditional Use EC
❑ Single Family 0 Garage Attached/Detached ❑ Discretionary"D"o tl ed Use Classification
`y ' Manufactured Home ❑ Modular 0 Special Use(Esse ilaVR lic Facilities)*?
❑ Commercial* El Boundary Line AdjtlstrInen - - `' .
❑ Change of Use ❑Short Plat** ! iJ ., V
❑ Address ❑Road Approach ❑ Binding Site Plan*"
El Home Business ❑Cottagelndustry ❑ Long Plat** JEFFERSON COUNTY
❑ Propane El Planned Rural Resitientia)merkl l till FiBfidme s**
❑Sign 0 Plat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions**
❑Stormwater Management ❑ Shoreline Management Substantial Development'"'
❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Variance
❑Temporary Use El Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium 0 Tree Vegetaion Request
*May require a Pre—Application Conference **Requires a Pre-Application Conference
Please identify any other local,state or federal permits required for this proposal, if known:
I• /r' DESIGNATION OF AGENT
I hereby designate t!t/ • /Liz( ;<<l:,,.i to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE utti.Q 4 Date: 9 /y— '7..v12
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 it's 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 Jeffer on County as a result of or in consequence of the granting of this permit.
l further agree to ovide acces n right of entry Jefferson County and its employees,representatives or agents for the sole purpose of application
r iew an equired lat�e�r/' sp ions. Staff access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the ap nation Pe or ants prio notice.
"gnature: i C/ Date:
The a " or,actions Appli t will undert e s a result of the issuance of this permit may negatively impact upon one or more threatened or
endangered species and could lead to a pc ten ial"take'of an-endangered species as those terms are defined in the federal law known as the
"Endangered Species, t"or"ESA."4ffe4son County ma s no assurances to the applicant that the actions that will be undertaken because this
permit has been issti d will not violate t ESA. Any inc" ;dual,group or agency can file a lawsuit on behalf of an endangered species regarding your
action n if y ' are in cornplian ith the Jeffers County development code.The Applicant acknowledges that he,she or it holds individual
and on-tr -fe le resp nsibility f a ering to an complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signa ure: ' 2 ! J/ =/%'l.l.-e," / Date:
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. j
Signature: Date:
GENE L CONT CTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
J/C(. - /� `�'-rn,)- ( .5 0) L,,c 'l -D77 7 (a (;f'/ -C�7efO
MAILINGIADDRESS: _ EMAIL:
7 S 9�C�.� ��l��t- is / �'��,`�«:�r,
CONTRACTOR'S LICENSE � G' WAINS
NUMBER: ` (�A2X/l )`. Df JO YL e NUMBER �1 AO y Cy' i/Ax-
ARCHITECT/ENGINEER: /
(f�,J/v,9c, /,�' i)�.--� PHONE ( ) FAX:( )
MAILING ADDRESS: �!��`& EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
X New ?( Wood Existing: ❑ Sewer
❑ Addition ❑ Steel Proposed: 2 Bank ❑ Community System
El Alteration/Remodel 0 Concrete Total: 7. Height: Individual System
❑ Repair ❑ Masonry SEP Permit# 12--( it-4
Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: Iiii Private well ❑ Two Party
Type of Heat: Proposed: ? ❑ Public
GEC-.-0J-/C. Total: 2_ Name of System: 1C(h
If this is a Commercial Project you must answer the following:
Number of Parking Spaces: Current: Proposed: Number of ADA Parking a
Number of occupants(includes owners,tenants, employees, etc) Current Proppf j --i
IBC Occupancy: IBC Type of construction: Will you have Fobtll
If this is a Propane Tank and/or Appliance Installation permit, mark all items below that applifi-i)
❑Underground Tank 0 Above ground Tank Size of Propane Tank: FM)+f ii , . 1
❑Heat Stove El Cook Stove 0 Woodstove ❑ Fireplace Insert 0 Hot Water Tank 0 Pellet Stotr Other
L))
Is this appliance being installed in a Manufactured/Mobile Home? Yes / No LI 31
When applying for a permit to install a propane tank you must also submit a site plan showing all of trieFtC ofircgsatii property
lines, tank location and size, distances from the propane tank to all property lines,buildings anct$VIO rSyStfiM'cpr pp{ReJts,
including the reserve area.
Square Footage Current Proposed For Office Use Only Amount Revision
Main Floor Heated EH Bld App Review:Aq r-ac
2nd Floor Heated Consistency Review: 222;
Other Heated Base fee:
Mezzanine Additional Section:
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL
Decks 911/Rd Approach fee:
Other TOTAL: $ (23''
Receipt Number: 1 352- 7'CD
Cash/Check Number:
2D
ESTIMATED COST(REQUIRED) Date:
.Fair market value of all labor and materials foundation to finish
Initials: �' _ --�- ^,
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JACK WESTERMAN III
Jeilemon Comity Courthouse
ASSESSOR PO Roc 1220, Port Townsend, WA 98368
(3600 383-9103
MOBILE HOME INFORMATION FORM
OWNER'S NAME/MAILING ADDRESS:
NAME: L 41Z/iS OAVZFX w- 1J S4- P;',e6
ADDRESS: O .60X Pi 3 / r Abek e ek ail 963 3 9
PRONE NO. 366 -38 5-z 3OS
The purpose of this questionnaire is to obtain information regarding either the
current location of a mobile home or the previous ownership and location of a mobile
home. This will help our office determine whe I ready on the
tax rolls in Jefferson County or if it has been III ,.;';t1 F: other area.
l)MOBILE HOME DATA: OCT - 4 2012
(A) MAKE e$r6� /J F. ,
Yn C S (B) MO E _.d��r y' - COUNTY ( 1 YEAR Zl7/Z
, I. NT
(D) LENGTH 27 (E)WIDTH 4L.8 (F)SERIAL# • 5.2
(G)YOUR PURCHASE PRICE(Do not include sales tax) (GU,COO- PURCHASE DATE'? `�
2)PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 3)
(A) FROM WHOM DID YOU PURCHASE MOBILE
ADDRESS
(B)WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR?Yes No
If Yes, Previous address of mobile.
If No, What County was Mobile assessed in last year.
3)WHERE MOBILE HOME IS TO BE LOCATED:
(A)WILL THE MOBILE HOME BE IN MOBILE HOME PARK? Yes No
(B)IF LOCATED IN MOBILE HOME PARK:
NAME &ADDRESS OF PARK Lot/Sp
(C) 1F NOT LOCATED IN MOBILE HOME PARK:
NAME OF LAND OWNER:
LOCATION ADDRESS 57 iY ,2 9 /d9y )'Der Acd0C-+C 1.1)01 9(.;,7
REAL PROPERTY PARCEL #/DESCRIPTION 94z 9,360 I
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THANK YOU FOR YOUR HELP! nature of F1
ejD„$ Q Q
JODI' COSSELL, Property Technician
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JACK WESTERMAN I140
ASSESSOR Jefferson day Courthouse
PO Boa 1220, Port Townsend, WA 98368
(360►385.9105
MOBILE HOME INFORMATION FORM
OWNER'S NAME/MAILING ADDRESS:
NAME: (1 ,e w- L - ke-A)
ADDRESS: .0 d pQr. xicik
PHONE NO. `"�
The purpose of this questionnaire is to obtain information regarding either the
current location of a mobile home or the previous ownership and location of a mobile
home. This will help our office determine whe a he tax rolls in Jefferson County or if it has been , ,zi ��, �' � ready on the
; nother area.
kli 1
1)MOBILE HOME DATA: 0C1 - 4 2012
r '
(A) MAKE r ,e T .
(B) MO I EL . ..4 ,F„y _' COUNTY
A.
•"1 ' , 1 ' vmENT 11 YEAR 2C/2_
(D) LENGTH_ z.7--�_(E)WIDTH
4(F)SERIAL#� 2 {'1
11611 YOUR PURCHASE PRICE(Do not include sales tax)2_00,LGG PURCHASE DATE Q4/z r
2)PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 3)
(A) FROM WHOM DID YOU PURCHASE MOBILE
ADDRESS
(B)WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY
LAST YEAR?Yes Na ')
If Yes, Previous address of immobile. �'
If No, What County was Mobile assessed in last year.
3)WHERE MOBILE HOME IS TO BE LOCATED:
(A) WILL THE MOBILE HOME BE IN MOBILE HOME PARK? Yes N�
(II)IF LOCATED IN MOBILE HOME PARK
NAME de ADDRESS OF PARK
Lot/Spare #
(C) IF NOT LOCATED IN MOBILE HOME PARK:
NAME OF LAND OWNER:
LOCATION ADDRESS -` ,y,e 4 A% T �i1�� er Ac//O i 9 3
REAL PROPERTY PARCEL #/DESCRIPTION 2 9 OD
THANK YOU FOR YOUR HELP2 mature sf applicant
4iT1.. 'gm S.S • 1
JO I COSSELL, Property Teehnielan
FERENZ BLD12-313
51 MARGARET WAY MLA12-218
Approvals Req'd Prior
to Final Inspection
SEP
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