HomeMy WebLinkAboutBLD2007-00501 - CANCELLED Jefferson County Building •sionPermit N -r: BLD07-00501
Applicant: BEST
BUILDING PERMIT INSPECTION APPROVALS \pplicable Code: 2006 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
Rough-in Plumbing
Framing
Airseal
Insulation:Walls
Insulation: Floors
Insulation: Ceiling
Wallboard Nailing
Mechanical Systems
Address Posted
Miscellaneous
FINAL INSPECTION
FINAL INSPECTION MUST BE APP O IS VD PRIOR FOR o O BUILDING BEING OCCUPIED
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, `$fliv 006. JEFFERSON COUNTY QEp 1 3
rzi �; DEPARTMENT OF COMMUNITY DEVELOPMENT , .., pr
' > 621 Sheridan Street• Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
.,q,ifINO,. p www.co.jefferson.wa.us/commdevelopment ,;t,- . .
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Master Permit Application 0 r•t' X ik C`"C/f`w" MLA: No MA. 'act.) IC41a,
Prglect DAcrrinfinn/ir.i..-+� ._�.-_ 1 �- Ai.__.��
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Tax Parcel R p /� 1 Property
Number: { )—.11 I V 0 Size: 31 or) acre S (acres/square feet)
Site Address and/or Directions to Property:
37 b 1. OQ..k �� a
Property Owner(s)of Record: l Jcf a t1 QSt
Telephone: L1 3 7, 8D ()I1 . Fax: Li 3r) , Li Sl email: ty &i C.S c)ear1tIitk,net
Mailing Address: 3 (h ( nak 6. Dar
Applicant/Agent(if different from owner A
Telephone: f Fc: email:
Mailing Address:
What kind of Permit?(Check each box that applies
KIBuilding ❑Variance(Minor, Major or Reasonable Economic Use)
❑ Demolition Permit ❑Conditional Use[C(a),C(d), or C]*"
A Single Family ❑Garage Attached/Detached ❑Discretionary"D"or Unnamed Use Classification
❑ Manufactured Home ❑ Modular ❑Special Use(Essential Public Facilities)**
❑ Commercial* ❑Boundary Line Adjustment
❑ Change of Use ❑Short Plat**
• ❑ Address ❑ Road Approach ❑Binding Site Plan**
❑ Home Business ❑Cottagelndustry ❑Long Plat**
❑ Propane ❑Planned Rural Residential Development(PRRD)/Amendments**
❑Sign ❑Plat Vacation/Alteration**
❑Allowed"Yes" Use Consistency Analysis Li Shoreline Master Program Exemption/Permit Revisions**
❑Stormwater Management ❑Shoreline Management Substantial Development**
❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Variance
❑Temporary Use ❑Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium ❑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:
\r DESIGNATION OF AGENT
I hereby designat- Iv 4, to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE t-[, Date: C(/f 3 / 0
ri
By signing this application,4 111
he 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. '• :terial 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 II 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
time of the a...cation that he or wants prior notice. r7
Signature: `•�..._.. Date: �f I//0 1
The action or acts Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or
endangered specie 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-tr ferable responsibili r adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: Date: U/I7 &7
C:Ai)ocumenrs and Settings\carat\1.ocal Settings VTemporary Internet files\O1,K86\Master Pcrmit Application 12-19-2006.doc
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BUILDER STATEMENT
The signer of is 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 asN,,; ing the respon . ility of the General Contractor for the proposed project.Signature: \ J1'7/0 c 1 3
Date: / pEP
GENERAL CONTR 1 OR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
( ) ( )
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE g
. WAINSNUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
New k Wood Existing: _L__ lii Sewer
Addition I Steel Proposed: 3,., Bank 1 Community System
X Alteration/Remodel 'I Concrete Total: 3 Height:1 V. Individual System
Repair k Masonry 1 6 0 7.. SEP Permit#
' Demolition Other: Bedrooms: Water Supply:
Existing: 2-" _ Setback: X Private well 1 Two Party
Type of Heat: Proposed: _ Public
L1ee,"�r; Total: 7 S Name of System:
If this is a Commercial Project 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:
0 Underground Tank 0 Above ground Tank Size of Propane Tank:
❑Heat Stove 0 Cook Stove 0 Woodstove Q Fireplace Insert 0 Hot Water Tank 0 Pellet Stove 0 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. •
1/013
Square Footage Current Pro osed 1l IC2
P �vrl��tf Only Amount Revision
Main Floor Heated cs Bld App Review: 0Q�D `� ` ` `v" r NA I�0� 'Floor
Heated
onsistency Review: N A _
Other Heated Base fee:
a3,.15 �8 is-. 55. CO
Mezzanine Additional Section:
Heated Basement Plan Check fee:
�.oq 54 313 .90 agC4 . (L1
Unheated Basement State Surcharge fee: w
Other Unheated 1(^ Pot Water Review fee:
Garage/Carport SUBTOTAL -1
Decks •
1�ti7g ��soots-
/ ,
I 911/Rd Approach fee:
Other /lr b TOTAL: $
Receipt Number: I a aCQ(D
ash/Check Number: o�
tal
ESTIMATED COST(REQUIRED) QI:78a
� Date: I Od�
.Fair market value of all labor and materials foundation to finish �1 I t?I 07 c 6 i CQ "Z
1 I j- V U D Initials: J
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