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Home My WebLink AboutBLD2012-00321 itILDING PERMIT APPLICATS BLD12-00321 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD12-00321 Received Date: 10/11/2012 SITE ADDRESS: 60 ADMIRALTY LN 325 PORT LUDLOW, 98365 OWNER: GLEE A HUBBARD TRUSTEE PHONE: 360-437-7325 HAROLD R HUBBARD JR TRUST 60 ADMIRALTY LN UNIT 325 PORT LUDLOW WA 98365-8289 THE ADMIRALTY#2 SUBDIVISION: Block: Lot: 1 PARCEL NUMBER: 990300209 Section: 9 Township: 28 N Range: 01 E CONTRACTOR: DAVE JOHNSON CONSTRUCTION PHONE: (360) 385-9028 314 PROSPECT AVE PORT TOWNSEND WA 98368-4700 Contractor's License DAVEJC*0440Q Expires 9/1/2014 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr INSTALL NEW WINDOW TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION 1,000.00 MAIN: CODE EDITION: 2009 ADD'L: HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: CONST TYPE: OTHER: GARAGE: SHORELINE CONST TYPE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routinq Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $38.75 LYK 10/11/12 135286 APPROVED Plan Check $25.19 LYK 10/11/12 135286 State Building Code $4.50 LYK 10/11/12 135286 UL y 2012 Total: $68.44 Jefferson County Planninc; & Building Department \\firlomorL\rl ofo\fnrrne RI f1 Ann Rlrl rnf 1(f11/9M9 Jefferson County Building Dion Permit Numb'T 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 '1`s-12. FINAL INSPECTION ,3, rP7- 20(2. FINAL k.PECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR IT SOIv cat, JEFFERSONUNTY • DEPARTMENT OF COMMUNITY DEVELOPMENT 14 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax iiiNG .q O www.co.jefferson.wa.us/commdevelopment s. Master Permit Application MLA: F MCA- Project Description (include separate sheets as necessary): IO�AAmb in.) L.JA_l.L. i1ld HY6, I•jtoP.6L 70 1AlSTALi, IS'")C ,Dd. IN)No- pbJ Tax Parcel Number: q c O 3 of .e 9 Property Size: (acres/square feet) Site Address and/or Directions to Property: to Ap/h7/2A)- LN. PoRT LuOLoW i 1✓4 14 3,25 Property Owner(s)of Record: C L 66. )4 v RR A(1. Telephone: q 3 r , TO.f Fax: email: Mailing Address: SAyr►,Fs Applicant/Agent(if different from owner): D AV 6 S 0)4 N s a d C ' N el Telephone: 3 D y' iv I. I Fax: 31441 , 1)/ 3 I email:3-.4N So p q ds g re "13;4 J64p Mailing Address: 3 �1 e tP f T I.✓ R g3 0 ' Clot. What kind of Permit? (Check each box that applies ❑ Lot or Road Segregation ❑Building 0 Critical Areas Stewardship Plan ❑ Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use) CS Single Family ❑ Garage Attached/Detached 0 Conditional Use[C(a), C(¢?o ** �nn 0 Manufactured Home 0 Modular 0 Discretionary"D"or U�jp � #iT rtla ll) 0 Commercial* 0 Special Use(Essential Public F-aciiitiesT" L Change of Use ❑ Boundary Line Adjustitient ❑ Address 0 Road Approach 0 Short Plat** \ . OCT 1 1 2012 ❑ Home Business ❑Cottage Industry ❑ Binding Site Plan**1 ; 0 Propane ❑ Long Plat** ' u L.' ❑ Dip ❑ Planned Rural R sident end ents** ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alt ratio *' MYCIStormwater Management ❑ Shoreline Master " ❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development** ❑Temporary Use 0 Shoreline Management Variance ❑Wireless Telecommunication* ❑ 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: DESIGNATION OF AGENT I hereby designate VP v/t 1 p t,f 51 DA1 to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE_742ft. ra. Date: /O/10720/2- 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 an 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 ap ication that he or she wa is prior notice. Signature: et a �-�� Date: /`O _; 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. ou are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transf ble respo ilit f hering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: 1 t Date: /O /U Q!l/Z 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. Signature: Date: —� FAX' .NERAL CONTRACTOR O(R PHONE: MANUFACTURED HOME INSTALLER: ' EMAIL: ( ) ING ADDRESS: CONTRACTOR'S LICENSE WAINS NUMBER NUMBER: ARCHITECT/ENGINEER: PHONE ( ) FAX'( )— MAILING ADDRESS: EMAIL Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: Project Type: J Wood Existing: Sewer r New Proposed: Bank Community System LT: Addition El Steel Total: Height: E Individual System Alteration/Remodel El Concrete — SEP Permit# _ Repair ❑ Masonry I Other: Bedrooms: pp y: Demolition Existing: Setback: Private well ❑ Two Party Proposed: Public Type of Heat: Total: Name of System: If this is a Commercial Project you must answer the following: Number of ADA Parking Spaces: Number of Parking Spaces: Current: Proposed: Number of occupants(includes owners,tenants,employees, etc) Current Proposed Type Occupancy: IBC T e 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 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. Amount Revision Square Footage Current Proposed For Office Use O ly App Review: Main Floor Heated EH Bld 2nd Floor Heated — Consistency Review: Other Heated Base fee: 54 • `15 Mezzanine Additional Section: OO Heated Basement Plan Check fee: , 3 )CI Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: $( 3 Ltil Receipt Number: ,5 Cash/Check Number: 84_76 4 ESTIMATED COST(REQUIRED) Date: +_ *Fair market value of all labor and materials foundation to finish Initials: ._.- . !. ,yuil„r`n 1 rC1114 J1\1-,...,1mnn'rC\r.. TfTI r-\1.f n_ :. A__1:_... C 7(1 CIO A...-