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HomeMy WebLinkAboutBLD2000-00118I . . i ILDING PERMIT IS c Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: , BLD00-00118 Received Date: 2/17/2000 SITE ADDRESS: CERTIFICATE OF OCCUPANCY Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 (360)379-4450 FAX(360)379-4451 Carl Smith, Director/Building Official PERMIT#: BLD00-00118 APPLICANT: GARY USA PHONE: DONNA USA PO BOX 430 CHIMACUM WA 98325-0430 SITE ADDRESS: 445 LARSON LAKE RD Issue Date: 04/28/2000 CHIMACUM, 98325 Final Date: 7/3/2014 SUBDIVISION: Block: Lot: PARCEL NUMBER: 801105014 Section: 10 Township: 28 N Range: 1W PROJECT DESCRIPTION:garage with ADU above THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 1997 EDITION. OCCUPANCY GROUP: R-2 TYPE OF CONSTRUCTION: 5N SPRINKLER SYSTEM yes no THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 7/3/2014 \\tidemark\data\forms\F_BLD_Occupancy.rpt 7/7/2014 OWNER BUILDER STATEMENT The signer of this statement does hereby certify that they are the Owners of the parcel referenced here,that they are not licensed oonlractors and-that they will be assuming. e responsibility of the General Contractor for the proposed project. Signature: '6(' -r--- Date: 9/z3/o JAN _4 GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAIN$ NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX ( ) MAILING ADDRESS: EMAIL 0 Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: GYNew li�Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: / ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: _ / Height: trYlndividual System ``__ ❑ Repair ❑ Masonry SEP Permit# 6.S 3 9 4' jik Bedrooms: Water Su ❑ Demolition ❑ Other: pP1Y• Existing: © Setback: Private well ❑ Two Party Type of Heat: Proposed: ! 0 Public Total: _/ Name of System: ystem: If this Is a Commercial Protect you must answer the following: Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces: Number of occupants(indudes 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: ❑ Underground Tank Above ground Tank Size of Propane Tank: Z 5 o G�►L, [r�Heat Stove C�Cook Stove ❑ Woodstove 0 Fireplace Insert 6Y1 of Water Tank ❑ Pellet Stove ❑ Other Is this appliance being installed in a Manufactured 1 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 Folr`Of(ice'UseOnly Current Proposed Amounts "�; 4 �4 Main Floor Consistency Review ,I-,�) - :; 2 u Fire cA At,— '76 J�- �i, �jr a t Iit ase fee: ,. 31°Floor Additional Section: /7 ti Mezzanine: h Plan Check fee: y 1r"_ Heated Basement Q(� State'Surcharge fee; felij Unheated Basement Pot Water Revief 911/Rd h fee: Other Unheated Appr Garage/Carport 7 TOTAL:. $,,.. Decks Receipt Nrtmber. V 1 " °" Other Cis heck,Nun>b ESTIMATED COST(REQUIRED) Datle: J *Fair mark ue of aH labor and materials foundation to finish l� � Initials. % G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc ON JEFFER COUNTY i---- ---- l DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend •Washington 98368 �A N 2()p� 4 .0, .F 360/379-4450. 360/379-4451 Fax gs N �e iVww.co jefferson.wa.us/commdevelopment - _ Master Permit Application rt.)1 s r(/k MLA: Project Description(indude separate sheets as necessary): /� / C14�1u66 G/�1R/1 bG l�F/CiA,/64rrO S TO 2AG� i31 To /ak J,)c.c a2 r Utveui..e a (tr/?- Tax Parcel Property Number: '2011 OSOI K Size: 6 , /00 Ac4 (acres/square feet) Site Address and/or Directions to Property: 91/5 1-/ a 2 3a,4-1 L let- k0.1 C4 rm,n cu,.? i 11)4. g >3 Z r Property Owner(s)of Record: is R.-, Li USA A u n DO X4.1.,,1 G , 61,5'4 Telephone: Sq./7- 2 2.3- 9117 I Fax: email: 3,143, Q e e oMC,osr,Nc r Mailing Address: /7 N. 2....4,''c Ave-. I7Nn'Rn 24/C6- i IL. 6 003 0 Applicant/Agent(if different from owner): x✓.i.t,n y Cat?Tc i Telephone: 3 6 0- 73 Z- O 73'7 Fax: email: Mailing Address: 414 LA 25 c.4 LA eer /20, ) 04 emA cac„, , /.JA. ,Y3 2 5- What kind of Permit?(Check each box that applies) tW uilding ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit ❑Conditional Use[C(a),C(d),or CI** ❑Single Family ❑ Discretionary"D"or Unnamed Use Classification 0 Garage Attached/Detached ❑ Special Use(Essential Public Facilities)** ❑Manufactured Home ❑ Boundary Line Adjustment ❑Modular ❑ Short Plat** ❑Commercial* ❑Binding Site Plan** Cli hange of Use ❑ Long Plat** 0 Address 0 Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** l 4 ropane ❑ 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 ❑ Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment 0 Forest Practices Act/Release of Six-Year Moratorium *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: DESIGNATION OF AGENT A I hereby designate le1.14 4Y C,a 2.?c--1 to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: 9/z; /d.5— 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 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.Access and right of entry to this property shall be requested and shall occur only during regular business hours. k_c q Signatu re: — Date: //Z 3/2 5- 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 if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferable sibility fi adhering to and complying with the ESA. The Applicant has read this disclaimer an signs and dates it below. Signature: Date: 9 a3/04— G:\PemtitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc k ryda"s:•a , • r i • r I 11 _— . . ; : .. , i .,:. :. ... : : ; .., .. ;;. „....1.,......_) .•_-_-,;:__:_ot:._,?:,4..7' i .. . : -1.. , . , . � /_. _4 �: Ay 10 ii I1 • b .' :'k:a . � 1 _+ ✓N'r.':r— .....� r I' YII�^�v� ��/a°."_......'w Payi � _,,' '''':''' :' • < - v 1 1 L ," § , ' y ./ / k ■ �_ cI\ 111 • ' i • . •riNI! .' -111%. . ;(7'<j.e. ' - '' r — . I � ' • / �- 4— _ 1 ir-' : __ < y e^� ✓ i t f .; • r y b� � , . I _ -, �." _ - �t�...,r.�---.....+n,.-..�-,���zr.�.--� • .-�-!/.ter.�7 • j 11! 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O•. . . • . • . . . . . . .,,..„. .� . . . ....___ . . , -7,-; r I* lYR • rim./ • •Jefferson County Department of Comnuudty Deueloliment I - �4,;o/v 6oG 621 Sheridan Street,Port Townsend WA 8 8[3601318-4450 4. o e - 0 o ti `, ? rmoo Project Description: Building Type: Project Type: Frame Type: Single Family ❑ New ❑ Wood ❑ Addition ❑ Steel ❑ Garage Attached/Detached ❑ Modular ❑ Alteration/Remodel ❑ Concrete ❑ Commercial ❑ Repair ❑ Masonry ❑ Multi-family/#of Units ❑ Demolition ❑ Other ❑ Industrial ❑ Other: s Bedrooms: Bathrooms: \ � Type of Sewage Disposal: Type of Heat: Dose one: Existing: Existing: ■ Sewer ❑Community System ❑ Electricity ❑ Oil Proposed: Proposed: ■ Individual System ❑ Woodstove ❑ Propane Total: oral: not sewer,fill out the following: ❑ Heat Pump u !4 Conventional ❑ Alternative ❑ Other Permit# SEP Water Supply: ❑ Private wed ❑ T, o P:,,,4 Well 11 Pub ,:Name of water system: Square Foo--ge: For Office Use Only `' Main Floor UBC OCCUPANCY GROUP e2-��65, 2ND Floor Base fee C� o " 3rd Floor _ 4 ` Plan Check feep se Htd Basement State Surcharge fee 1�/ Subtotal 7'& . 3�`.3 Unhtd Basement Garage/Carport Pot Water Review fee a + Decks ti �`.. 11/RdApproachfee a/ Q o Commercial / T ''i D S Industrial r\ Re -0 Other �'�i�.- # �� Total Val ,ti.d: ir Or s- 1 Dat: ,-,..,‘Estimated Cost: \H 0, If within 200' of the Shoreline Distance to Bank or Ordinary High W. er Mark ft.B /ft. By signing the application form,the applicant/o• attests that the information provided herein is true d co to th .est of their lt3to e. Any material f ehood or any omission of a material fact made by the applicant/o er with respect to this applicanon packet may resin this p b`�g d void I further agree to save,indemnify and hold h ss Jefferson County against all liabilities,jrrdgmenu, ourt co ? ..nable attorney s fees and ex 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 it's employees,representativ or agents for the purpose of application review and anyrequired later inspections. Access and right of entry to the applicant's property or structure shall be requested and shall occur during business hours. Date: Signature: d a n or CL n r r 5. vi m Q = r z e °' 0 3 _ r It C) D 0 x � i isro ey 9,jj v 9 o xiz -°T)o u' ��y Dti n jG to Z mD z y -I z (fit} .'�, o '11 9` x m ., Z -171 G C • O D n (h -I ti M N H , m n m v Y a 0 r - -c) 0 r �� 0 td -n C r Z t7 D SETBACKS Z v,A A c►1 Y xd r4n C. E. Bab b �_ �. a� � e o cm, B 5: a p p a ;, a ° a, p a N a m w l a `� N• d `� �a Alt* h' w (FDA /� F� �/� G ~ (/� p !^, rte{ O :^ z (A VI f 43 F o pp q ° i^, 'ti� ►� 1� '. .air CltV - r c,., k,. b 5 , o p d .. �N r9" b. • g.:: ::]:i.:.: k�° 0 0 0 :.:,::.:. :;.;: . \t‘, R , ,,, .4,-.• '--4 :::::.:.: ::::.. ., ::::: :::: 1). M ..... 0 n....6 ti � um" I � Co k fD � °� d . , � 3 a rn w �3 ri.— _ P44. a ::::.. :.:::::: \ , s> X .--\.'c.:2) c325 q • ____, , ::::.: :.:.:::. x Ci ,--d ,-d v G x .. c, c, c, a!i o W y,4 O &.. .. ._ -- moomoo"* "*, m Cia .. fkij: H y �. co iic W co V o CO ,C7 H i � Y 5 ��—�-' BUILDING PERMIT APPLICATION Jefferson Jefferson County Department of Community Development _ 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD00-00118 SITE ADDRESS: LARSON LAKE RD Received Date: 2/17/2000 CHIMACUM, 98325 APPLICANT: RANDALL CARTER 1821 E MARROWSTONE PHONE: (360)379-8038 1 NORDLAND WA 98358 C C SUBDIVISION: MT TOWNSEND VISTA PARCEL NUMBER: 801105014 Block: Lot: 20 , Section: 10 Township: 28 N Range: 01 W _J CONTRACTOR: OWNER j PHONE: —1 ARCHITECT/ q0)\'5t1\l'‘AUMOCK DESIGNWORKS P-- • Q\ ENGINEER : KIRK BOIKE / • 2303 HENDRICK T u►pr +� 0� PORT TOWNS D ■ ' •8368 go ■ -awe INwte ii - - PROJECT DESCRIPTION: --- \.0 TYPE OF WORK RES SQUARE Fe•TAGE: 1 TYPE OF IMP ADU VALUATION 37,576.00 MAIN: 576 CODE EDITION: 1 997 ADD' HEAT TYPE: EEE OCCUPANCY: R_3 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: CONST TYPE: 5N OTHER: CONST TYPE: GARAGE: 576 SHORELINE: DECK: 24 SETBACK: SEWAGE DISPOSAL: CON BANK HEIGHT: WATER SYSTEM: PWELL �� - to WATER STORMWATER: YES NO V- AREA BATHROOMS: Wetland L'O Erosion WO Exist: c Exist: 2 i Seismic Prop: Prop: Pia Streams -1110 q ;�}-c 1- te, Prop: Flooding X/ Landslide / -Ant, Total: NO Plat Conditions Routing Date: Shoreline VC Aquifer wo 2 '2 3. Q() Forest: Commercial Rural !/' Proximity Type Amount Paid By: Date: Receipt: Permit p Approved/Date $522.55 MAM 02/17/00 25263 ebWila�I.BMI✓ Plan Check $156.77 MAM 02/17/00 25263 ( tY State Building Code $4.50 MAM 02/17/00 25263 I t Total: $683.82 Critical A,rea 1 Reviewy Aqi/i\p3 I.1F_BLD_App Bld.rpt 10/29/99 efferson County Department of&unity Development April 5, 200 621 Sheridan Street, Port Townsend, WA 98368 (360) 379-4450 CRITICAL AREA STANDARD WAIVER Applicant: RANDALL CARTER 1821 E MARROWSTONE NORDLAND WA 98358 Critical Area Review Case Number: CAR00-00077 Project Description: Accessory Dwelling Unit. Parcel Number: 801105014 S-T-R: 10-28N-01W Site Address: 445 LARSON LAKE RD CHIMACUM WA, 98325 FINDING: The development, as proposed and portrayed on the Universal Plot Plan, does not encroach on an identified critical area nor any associated buffers. CONCLUSION: The proposed development meets the waiver requirements established in Jefferson County Ordinance 05-0509-94. CONDITION: The development shall be as proposed and portrayed on the Universal Plot Plan. Deviation, additions or relocation of proposed development activities will require further review pursuant to the Jefferson County Critical Areas Ordinance. Departure of Community Development Staff c: File I:\F_CAR_Waiver_Standrd.rpt 12/13/99 • �. ,' RE: BUILDING PERMIT APPLICATION NO. 61--act--Or�1 l6:3 - ,\ PROP TY OWNER(S) lease Print) 4/),,go qndN rxrer L 1 LEGAL DESCRN 11 Alf MININZIiI111111111r Ti = Ae SITE DRESS arse/v7 Ia CONSISTENT WITH THE REQUIREMENTS OF JEFI-tRSON COUNTY INTER IN FOREST LANDS ORDINANCE (ORDINANCE NO. 01-0121-97), I AGREE TO PROVIDE ADEQUATE ACCESS FOR FIRE VEHICLES TO THE AFOREMENTIONED PROPERTY. SIGN•TURE OF EACH PROPERTY OWNER 1 / _ es� This form does not need to be notarized Please return to: Jefferson County Permit Center, 621 Sheridan Street, Port Townsend, Washington 98368 OWNER BtlILDER STATEMENT 1 The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein.that they are not tic based and-that they will be assuming e responsibility of the General Contractor for the proposed project l signature: 2 Date: 9/Zs�o�- t JAN ' I II GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE FAx MAILING ADDRESS: EMAIL: WAINS CONTRACTORS LICENSE NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: ' \ Shoreline: Type of Sewage Disposal: G VNew VlNood Existing: El Sewer po�a. ❑ Addition ❑ Steel Proposed: I Bank 0 Community System ❑ Alteration/Remodel ❑ Concrete Tor • Height: i'Individual System ❑ Repair ❑ Masonry SEP Permit# �' ^ 3 9 fK ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: g/-Private well ❑ Two Party Type of Hest:2 Proposed: ❑ Public Po AAA Total: Name of System: If this is a Commercial Protect 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 It this isa1.coDane Tank and/or. i instatlafion: erg dt mark ail hems below;tt# t i : ❑ Underground Tank l�Above ground Tank Size of Propane'Tank: ' Z 5o GSA L, WHeat Stove [Cook Stove ❑ Woodstove ❑ Fireplace insert ti4iot Water Tank ❑ Pellet Stove ❑ Other Is this appliance beano installed in a Manufactured I 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 or OtiiceUJse Only Current ' fir'"dposed ._ unt L 1 -t Main Floor Consistency Review: ,_ - �, kpr ��j,,� I� S ,z '�e�w�• Ky_', �lr, � x r 31O Floor ,,,Additional Section: -77---'-',' .� , , : "Plan yieckfeeMezzanine: -rge f x`"ate Sur a _ � � � � A O Heated Basement _�Ot Water� � � ; ' P ,Unheated Basement ,Other Unheated 911/Fd Approach n t Garage/Carport TOTAL: S Decks `Receipt idumb+ar �� � � � ; �'�Other sh eck-Nur 1p q 01{ f¢", 7. iaSTIMATEDC 'I'�!�); Date Fair ue of all Tabora d materials foundation n to fin ► 'I to X ; _ a Initials: � /` .ES N , + G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc C L'p 4 JEFFERSOI OU[VTY y DEPARTMENT OF COMMUNITY DEVELOPMENT _ i 621 Sheridan Street• Port Townsend•Washington 98368 JA 2006 ' s 3601379-4450• 360/379-4451 Fax e G,s• wow.co.jefferson.wa.us/commdeveklpment g_. s Master Permit Application r( u 1 s r 0 MLA: Project Description(include separate sheets as necessary): C/4/•gaGs- G/44Aas- id/Chi/44rso S?o4466- /)/i "To A.,4 Ac—c 55o/4r ,(JIdci_ise4 (.4eir- Tax Parcel Property , Number: ?(:)1/ 05-0)y Size: 6 4 /©O /.t«, (acxes/square feet), Site Address and/or Directions to Property: yZ/S LA2 so.y L lets /2D. C/-(r/r,.n cLk 0-1 i ).4 14. 9 8 3 2- 5' Property Owner(s)of Record: (pia 2d 1 Ll. tJsii /Jun o i, G . GC S4 • Telephone: pi/7- 2.23- 91/7 / Fax: email: 3c/45,, j e c.oMUOST,Ne.r Mailing Address: /7 A/. 2Ake— Avc. STN fit!) L uuc TL. 6 oo3 a Applicant/Agent(if different from owner): /1nNn y cAL,r0 2 Telephone: : 6 0- 73 2.- O 73 7 Fax: email: Mailing Address: .• s• I-, * - P0, _ f v cu. .J• ' 73 2 5' What kind of Permit?(Check each box that applies) building ❑Variance(Minor,Major or Reasonable Economic Use) ❑ Demolition Permit ❑Conditional Use[C(a),C(d),or Cj** 0 Single Family ❑ Discretionary"D"or Unnamed Use Classification ❑Garage Attached/Detached ❑ Special Use(Essential Public Facilities)** ❑Manufactured Home ❑ Boundary line Adjustment ❑ Modular ❑ Short Plat** ❑Commercial* ❑Binding Site Plan** i>WGhange of Use ❑ Long Plat** o Address ❑ Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** luePropane ❑ 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 ❑Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium *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: DESIGNATION OF AGENT A I hereby designate R4.44 0 Y CA/1-7G A._ to act as mIc agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: 94 c/•5---- 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 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.Access and right of entry to this property shall be requested and shall occur only during regular business hours. / Suture: (/�Lr_ Date: 9/z 3/v 5- 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 if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferable risibility f adhering to and complying with the ESA. The Applicant has read this disclaimer an signs and dates it below. Signature: Date: /�a 3/04— G:\PemutCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc i 0 . --ON Jefferson County Permit Center ' Department of Community Development N 7*`t� �° ' 621 Sheridan Street,Port Townsend WA 98368[360)379-4450 '> 2 0 .. r� ,o rm �t S,1rING(t ppvcavon Project Description: 2,,E.7,4 ,445.25 �4-,e,-6,E / L9 SLY bavELL✓Iv& UN/T w e, ' Building Type: Project Type: Frame Type: Single Family [YNew [ "Wood V Garage Attached/Detached ❑ Addition ❑ Steel ❑ Modular ❑ Alteration/Remodel ❑ Concrete ❑ Commercial ❑ Repair ❑ Masonry ❑ Multi-family/# of Units ❑ Demolition ❑ Other: ❑ Industrial ❑ Other: Bedrooms: Bathrooms: Type of Sewage Disposal: Type of Heat: Choose one: Existing: 4 Existing: ❑ Sewer ❑Community System -'LL l ectricity ❑ Oil Proposed: 1 Proposed: 11Individual System ❑ Woodstove 0 Pro ane Total: Total: If not sewer,fill out the following: ❑ Heat Pump ❑ Conventional ❑ Alternative ❑ Other Permit # SEP Water Supply: [Private well ❑ Two Party Well ❑ Public:Name of water system: fSquare Footage: / o For Office Use Only �m , '" d Main Floor _ UBC OCCUPANCY GROUP Z&Y1.= ✓ 13 2ND Floor 5 7 ,4��'l' -7(P Al se fee S22. SS' 1, 5 3rd Floor -ho AtL\ ''�to«!0= flan Check fee l c)(p."7- 7 1 l'. '4174! Htd Basement ._" State Surcharge fee , £ . , Unhtd Basement Subtotal � ! u4C2 . 3, � 0 Garage/Carport ..3-- 6' Si(Q 0 Pot Water Review fee '::. .1 Z.f.`' 0° t.� °0. Decks 911/Rd Approach fe_ Commercial — TOTAL —712. . % j e l2. ` . Industrial Receipt # 2 S2 ' . Other 24 (PJe 10 (] Cash/Check # 10y' Total Valuation: - ---►�,c %ttials klb,G\ Or (-k ate a.. 11• 10 Estimated Cost: 1oh ink► l= s l)']-f- ll I-f l , If within 200' of the Shoreline, Distance to Bank or Ordinary High Water Mark #1/1) ft. Bank Height ft. Signature: 0/72 / Date: 2.)--/ 2- 06 aPIi ` A 4 4• 1 ., BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 (360)379-4450 FAX(360)379-4451 (800) 831-2678 PERMIT #: BLD00-00118 Received Date 02/17/2000 1 SITE ADDRESS: 445 LARSON LAKE RD Issue Date 04/28/2000 CHIMACUM, 98325 Expiration Date 04/28/2001 APPLICANT: NDALL CARTER G19-r- V1/4) °S11' PHONE: (360)379-8038 1821 OWSTONE h N, LAICQ AU NORDLAND 8 Thir d LCLICe ( L1 L O30-c96 ) ) SUBDIVISION: MT TOWNSEND VISTA Block: Lot: 20 PARCEL NUMBER: 801105014 Section: 10 Township: 28 N Range: 01 W CONTRACTOR: OWNER PHONE: LOAN LENDER/ BOND HOLDER: 1 Cetilkl- � .��l a - ‘ \ • — •0 1 jr j PROJECT DESCRIPTION SATE .7E31-11M �,c Q_- REQUI- : , •ECT • : [ FooiItir •ac.: Shorelin Setbacks): 7 Y` 60 • [1.411 -: C7G` 7/z 7 Q6;\ k [ ] Underground Plumbing/Underground Insulation: [ ] Shear Wall: I ] Framing/Plumbing: (1.1„,,/,,t_49.6 6-3a-W r & 41:ALAA-- , -7 °7 f a I Propane Tank/Lines: . - ,_ - ±, _ 1 NFL&Pa Fee X/97 56J [ ] Insulation:°)i kl-L-C .. L-16 -/11"2-11v CaAg s topiu.5iitft. OK 0f3`/X I ] Sheetrock: 0 PPLf-P1\99(- y 7) al a‘ a< gio/ji [ ] Final/Occupancy Approval: `---1-5 - k I, b 1 HEALTH DEPARTMENT APPROVAL REQUIRED PRIOR TO FINAL INSPECTION. THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS. Office Hours 9:00 a.m. -4:30 p.m. MA/Kt 1. I At cf 7717 /� Inspector's Phone Hours 8:00 a.m. -13970.0 a.m. -2-A/r 7 /'? ECIAL CONDITIONS MAY APPLY -SEE REVERSE Ole- /4/1070 V Cf:F HOT LINE AVAILABLE 24 HOURS A DAY