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HomeMy WebLinkAboutBLD1995-00489r- . , • JEFFERSON COUNTY BUILDING APPLICATION Jefferson County Permit Center Castle Hill Mall 621 Sheridan St. Port Townsend, WA 98368 360-379-4450 PERMIT # •BLD95-0489 DATE RECEIVED. : 08/31/95 SITE ADDRESS:7670 CENTER RD :QUILCENE, WA 98376 APPLICANT. . . :SUSAN SJOLUND PHONE:732-4282 MAILING ADDR:PO BOX 1244 :PORT HADLOCK WA 98339 CONTRACTOR. . : PHONE: MAILING ADDR: : 0014572 CONTR. LIC #: EXPIRATION DATE: / / ARCHITECT/ . . : PHONE: DESIGNER • MAILING ADDR: PARCEL NO. . . :801174009 ALT: CON : LEGAL DESC. . :STR 17-28-01 WWM, TAX # BY: DATE: 9 ,/ /ô - LOT , BLOCK , WATER: ' y DATE: CAR :P"7 DATE: 9 / DESCRIPTION OF IMPROVEMENT: Garage BUILDING TYPE •GAR BEDROOMS--- BATHROOMS-- MAIN FL. . . : 0 sf TYPE OF IMPROVEMENT:NEW EXIST. : 0 EXIST. : 0 ADD'L FL. . : 0 sf GARAGE/CARPORT •D PROP. . : 0 PROP. . : 0 HTED BSMT. : 0 sf WOODSTOVE • TOTAL. : 0 TOTAL. : 0 UNHT BSMT. : 0 sf UBC OCCUPANCY GROUP: SEWAGE DISP. . :SEPTIC OTHER • 0 sf TYPE OF CONST • WATER SUPPLY. : CRPT/GAR. . : 1584 sf UNITS. : 0 STORIES: 0 HEAT TYPES. : DECKS • 0 sf DIMENSIONS: MOBILE HOME COMMERCIAL: 0 sf FRAME TYPE:WOOD MAKE: YR: INDUSTRIAL: 0 sf EST COST. $: 15840 SIZE: BANK HT. . . : 0 ft PROJ GRP. . : 6927 SH SETBACK: 0 ft Owner/agent 4 A , , " , FEES Signature: A L k type amount by date recpt AMR" PRMT $ 237. 25 AMW 08/31/95 111161 Date: ( PLCK $ 71. 18 AMW 08/31/95 111161 Issued By: ► � � B.C. $ 4 .50 AMW 08/31/95 111161 ?l:as �i JUG Date: $ 312 . 93 TOTAL ci (( i ty r JEFFERSON COUNTY PERMIT CENTER, 621 SHERIDAN ST, PORT TOWEND WA 98368 ¢ BUILDING PERMIT APPLICATION i / PROJECT DESCRIPTION: Z A R A G E . 3 4, x 141( BUILDING TYPE: PROJECT TYPE: FRAME TYPE: ❑ SINGLE FAMILY ,I:?' NEW 4 WOOD .4 GARAGE ATTACHED/DETACHED ❑ ADDITION El STEEL ❑ MODULAR ❑ ALTERATION/REMODEL ❑ CONCRETE ❑ COMMERCIAL ❑ REPAIR ❑ MASONRY ❑ MULTI FAMILY/# OF UNITS El DEMOLITION ❑ OTHER ❑ INDUSTRIAL ❑ OTHER BEDROOMS: BATHROOMS: TYPE OF SEWAGE DISPOSAL: EXISTING EXISTING SEWER ❑ COMMUNITY SYSTEM PROPOSED PROPOSED IN INDIVIDUAL SYSTEM ❑ Conventional TOTAL 0 TOTAL 0 PERMIT # SEP ❑ Alternative No PL.vnmgirNq I,J GARRgE WATER SUPPLY: TYPE OF HEAT: 1$1 PRIVATE WELL No v1/4116.1. %ij C14/ 41c1 ❑ ELECTRICITY ❑ OIL ❑ PUBLIC Name of water system: ❑ WOODSTOVE ❑ PROPANE ❑ HEAT PUMP fJ OTHER: Ni O),IE SQUARE FOOTAGE: MAIN FLOOR 2ND FLOOR FOR. OFFICE:USE ONLY 3RD FLOOR UBC OCCUPANCY GROUP HTD BASEMENT UNHTD BASEMENT CARPORT BASE FEE GARAGE 15g Li PLAN CHECK 8 Li DECKS '�/ 'STATE SURCHARGE 4.50 COMMERCIAL TOTAL I 2.-'9 INDUSTRIAL OTHER TOTAL VALUATION I ` RECEIPT 1/ ! /( i Or ----„m, CASH ! 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Is there any standing or running water on the surface of the )( YES NO property or on any nearby property at any time during the year? If YES, please describe: PO DeI4)S A/01) Ru& o Cf 2. Has any portion of the property or any nearby property ever been YES _LNO identified as a wetland or swamp? If YES, please describe: 3. Are any willows, skunk cabbage, alders, or cottonwoods present )( YES NO on your property or adjacent properties? If YES, please describe: 4. Are there any indications on any portion of the property or on any YES ,k NO nearby property of rockslides, earthflows, mudflows, or landslides? If YES, please describe: 5. Please indicate which line best represents the steepest slope found on your property. (Check appropriate box) o a 4 Q ❑ o ,0 / / , , , � . / / , ,� / / iiii// // i ❑ „ iiii / , / ,' iiii%%/ ,'� Fri 1///// / / iiii i • 6. Does the site have steep slopes with little to no vegetation? YES NO t If YES, please describe: 7. Does the site contain high percentages of silt and/or very fine YES r NO sand? If YES, please describe: 8. Does the site contain ground water seepage or springs near the YES NO surface of the ground? If YES, please describe: The applicant hereby certifies that all of the above statements and the information contained in any other transmittals made herewith are true, and the applicant acknowledges that any action taken by Jefferson County based in whole or in part on this application may be reversed if it develops that any such statement or other information contained herein is false. Signature Date -ZS °'ci J iii-�/41i-1"s 10V FOR OFFICE USE ONLY ❑ Wetlands ❑ Seismic CRITICAL AREAS ON OR ❑ Aquifer Recharge Area (zone ) ❑ Fish & Wildlife Area 1 IMMEDIATELY ADJACENT TO SITE: ❑ Frequently Flooded Area ❑ Fish & Wildlife Area 2 ❑ Erosion ❑ Landslide Zone: Parcel Size: Status: Comprehensive Plan Land Use Designation: Reviewed by: Community Plan: Date: