HomeMy WebLinkAboutBLD2009-00339 THIS BUILDING IS
NOT FINALED .
THIS IS AN INCOMPLETE
BUILDING APPLICATION . THE
PERMIT WAS NEVER ISSUED .
03UILDING PERMIT APPLICAN MLA09-003 Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD09-00339 Received Date: 10/6/2009
SITE ADDRESS: 8457 SR20
PORT TOWNSEND, 98368
OWNER: BARNEY'S INVEST& LEASING LLC PHONE: (360) 829-9049
SYLVIA HENDRICKS 50%
28280 STATE ROUTE 410 E
BUCKLEY WA 983219212
SUBDIVISION: Block: Lot: +
PARCEL NUMBER: 001212017 Section: 21 Township: 30 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: MICHAEL J ANDERSON PHONE: (360) 531-1011
330 CLEVELAND ST
PORT TOWNSEND WA 98368
PROJECT DESCRIPTION M/H OFFICE FOR ARROW LUMBER BUSINESS
TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL:
TYPE OF IMP NEW INDUSTRIAL:
VALUATION MAIN:
CODE EDITION: 2006 ADD'L: HEAT TYPE: EEE
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
CONST TYPE: OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL: ALT NUMBER OF EMPLOYEES:
WATER SYSTEM: CITY
BATHROOMS:
Exist: 0
Prop: 1
Routing Date:
.-Gsq
Type Amount Paid By: Date: Receipt: Approved/Date
Manufactured Homes $213.00 LYK 10/06/09 111063
Potable Water Application $62.00 LYK 10/06/09 111063
Total: $275.00
011T L,� � •
, ;a, JEFFERSON COUNTY
\ DEPARTMENT OF COMMUNITY DEVELOPMENT
'' '� 621 Sheridan Street• Port Townsend •Washington 98368
360/379-4450 . 360/379-4451 Fax
www.co.jeferson.wa.us/comrrdevelopment
Master Permit Application OCT -- 6 2009 MLA: 00(-3.215
Project Description(include separate sheets as necessary):
MA-NUF G TU2 NOitte A94 ARRo I 1.11/11136,2 eei'slAlE SS'p+ctc
Tax Patel Number: 00/ -.g/0 -O/7 Property Size: (acres/square feet)
Site Address and/or Directions to Property:
8¢57 mg,• 2�O! fo2T T1(II//JEr.1171 WA 143,3 6
Property Owner(s)of Record: E4 G .5//l/✓ c7'/,NTS 1. li�C
Telephone: X6 0 6Z1 V49 Fax: email:
Mailing Address: Ve50 00 #W1" 4•?O E Mie G6-`r' W,4 x,63 z/
Applicant/Agent(if different from owner): Gi/G:ffA ?.-. f+- fPerLScsJ
Telephone: -j6 o-03/-VU 1/ Fax: email:�Y.Yr Ile a Z e
Mailing Address: 130 44-6v6--/-04"/? P7. M4- g,0 $ GCY �Ge-A
.e0
What kind of Permit?(Check each box that applies 0 Lot or Road Segregation
,uilding ❑Critical Areas Stewardship Plan
❑ Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use)
❑Single Family ❑Garage Attached/Detached 0 Conditional Use[C(a),C(d),or C]**
Manufactured Home 0 Modular - 0 Discretionary"D"or Unnamed Use Classification
ommercial* 0 Special Use(Essential Public Facilities) ""
C ange of Use 0 Boundary Line Adjustment
❑ Address ❑Road Approach ❑Short Plat**
❑ Home Business ❑Cottage Industry ❑Binding Site Plan**
❑ Propane ❑Long Plat**
❑Sign ❑Planned Rural Residen`har Development
(PRRD)/Amendments**
❑Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration**
❑Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions*"
❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development**
❑Temporary Use ❑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:
,t DESIGNATION F AGENT
I hereby designate IC � 1///� 0A/to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE LA iA A A_A Date: 9/3i. /6\1
By signing this application f.ml,the owner/agent att 4 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 a y 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 re 'red later'y spections. Staff's access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the appli tiob the a ants prior notice. /
Signature: ` Date: `1 / t 1
The action or actions Applicant will uncle" sa 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 are in co liance with the Jefferson County development code.The Applicant acknowledges that he she or it holds individual
and non-transf bl r pon i i r hering t and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: Date: LII 3 C tt
BUILDER STATEMENT
The signer of " 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 ass,ming the,spon 'bility of ,Gene I Contractor for the proposed project. j
/Signature: / / / 113ate: !'e��7
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTAL R: PHONE: Fax:
( ) ( )
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
rect Type: Frame Type: Bathrooms: Shoreline: : Type of Sewage Disposal:
, New 0 Wood - Existing: S '❑ Sewer
❑ Addition 0 Steel Proposed: I, Bank ❑ Community System
❑ Alteration/Remodel 0 Concrete Total: Height:. 0 Individual System
❑ Repair ❑ Masonry SEP Permit.#
O Demolition ❑ Oiler Bedrooms: Water Supply:
Existing: , Setback: ❑ Private well ❑ Two Party
Proposed:
T of Heat: —L— 0 Public Ni
Total:
E L r.P.–j.C. Name of System:
If this is a Commercial Project you must answer the following: \�
Number of Parking Spaces: Current: –3 Proposed: Number of ADA Parking Spaces: 4)
Number of occupants(includes owners,tenants,employees,etc) Current I Proposed A u
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: v
1 Underground Tank 1 Above ground Tank Size of Propane Tank:
1 Heat Stove 1 Cook Stove 1 Woodstove i Fireplace Insert 1 Hot Water Tank 1 Pellet Stove i Other K
Is this appliance being installed in a Manufactured/Mobile Home? Yes / No V
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 Current Proposed R .e s _ k f` . g' r. . . ..: .fi-`_£ ;;L"c _ , . t,
Main Floor Heated k . °°• EH Bid App Review:
2nd Floor Heated ' Consistency Review: , / 0 d
—Other Heated 1 : Base fee: f -oo
Mezzanine , Additional Section: _
Heated Basement . '`' , .'-• Plan Check fee:'
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Review fee: /0 0 v 0
y£
Garage/Carport SUBTOTAL
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JACK WESTERMAN III Jefferson Connt.,.rirthonsc
ASSESSOR PO Box 1220, Port Townsend,OVA 98368
(360)385-9105
MOBILE HOME INFORMATION FORM
OWNER'S NAME/MAILING ADDRESS:
NAME: 11*/211/O'YS /M/ 7/øi&'7'5 L-LG
ADDRESS: ZF3Z 60 X1,0, 41a w,4 953z/
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 whether the mobile home is already on the
urn
tax rolls in Jefferson County or if it has been moved to this coigiy1i out': nother area.
l)MOBILE HOME DATA:
(A)MAKE E le,Z4. "R1 (B) MODEL AP (C)YEAR /”/
(D) LENGTH 60 1 (E)WIDTH #22 1 (F) SERIAL# /OO/10.4.
(G)YOUR PURCHASE PRICE(Do not include sales tax) PURCHASE DATE
2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 3)
(A) FROM WHOM DID YOU PURCHASE MOBILE /PfrO 4vrAil coAgriy't erms ht'!c
ADDRESS �..Q • .15' Z D I / i&:7,R 4442 GV4 q0t165
(B)WAS MOBILE HOME ASSESSED IN JEFFER 11I CEIV1iiiki LAST YEAR?Yes t
If Yes, Previous address of mobile.
If No, What County was Mobile assessed in last year. 04-
3)WHERE MOBILE HOME IS TO BE LOCATED:
(A)WILL THE MOBILE HOME BE IN MOBILE HOME PARK? Yes C
(B)IF LOCATED IN MOBILE HOME PARK: //^
NAME &ADDRESS OF PARK Nf• Lot/Space#
(C) IF NOT LOCATED IN MOBILE HOME PARK: /
NAME OF LAND OWNER: , �.�.�' /Al _. r/1/161-)73 GL-�
LOCATION ADDRESS 8¢.7 'Sim z 7 PT WT- qe ad
REAL PROPERTY PARCEL#/DESCRIPTION del ' /Z --O/
FJ Signat CZA..kk
e of applicant
THANK YOU FOR YOUR HELP!
Lauralee Kiesel, Property Technician
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STRUCTURAL CALCULATIONS
LATERAL ANAYLSIS
ARROW LUMBER CO.
#8457 HIGHWAY SR2O
Port Townsend, WA 98368
APN001212017
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EXP. DATE: 05 / 05 / 10
Michael J.Anderson
PE&PLS No.27665
330 Cleveland Street
Port Townsend,WA 908368
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STRUCTURAL CALCULATIONS
LATERAL ANAYLSIS
ARROW LUMBER CO..
#8457 HIGHWAY SR2O
Port Townsend, WA 98368
APN 001 212 017
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EXP. DATE: 05 / 05 / 10
Michael J.Anderson
PE&PLS No.27665
330 Cleveland Street
Port Townsend, WA 908368
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JACK WESTERMAN III Jefferson Comity Courthouse
ASSESSOR PO Box 1220. Port Townsend, WA 98368
4360) 385-9105
MOBILE HOME INFORMATION FORM
OWNER'S NAME/MAILING ADDRESS:
NAME: , A--AzA/t5'YS m T/1t .ITS L-z
ADDRESS: 2132. //WY# 4/0 F i>UGleI.c5y w,4 *53Z/
PHONE NO. —O " = —
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 whether the mobile home is already on the
tax rolls in Jefferson County or if it has been moved to this coufly-front another area.
1)MOBILE HOME DATA:
(A) MAKE E / ó Z t// (B)MODEL /r!-/ z (C)YEAR /4,q/
q/
(D)LENGTH 610 / (E)WIDTH I (F)SERIAL# /0'?//Q,l
(G)YOUR PURCHASE PRICE (Do not include sales tax) PURCHASE DATE
2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 3)
(A) FROM WHOM DID YOU PURCHASE MOBILE /4'//P4400' AIA had'
ADDRESS P.-0 . $' Z / O q / ilqI24,44i f4 tv.4 90083
(B) WAS MOBILE HOME ASSESSED IN JEFFERf1'W COCIIWili LAST YEAR?Yes
If Yes, Previous address of mobile. N/ ,�
If No, What County was Mobile assessed in last year. 6
3)WHERE MOBILE HOME IS TO BE LOCATED:
(A)WILL THE MOBILE HOME BE IN MOBILE HOME PARK? Yes C
(B)IF LOCATED IN MOBILE HOME PARK:
NAME &ADDRESS OF PARK Ni/
Lot/Space #
(C) IF NOT LOCATED IN MOBILE HOME PARK: /
NAME OF LAND OWNER: eA'7z Y'5 kvve //weAfi'5 GL- .
LOCATION ADDRESS 84',7 r7/e. 20 P.'T WA-- .18 ‘,=5
REAL PROPERTY PARCEL #/DESCRIPTION 00/ " Ti/Z '-0//
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Signat e of applicant
THANK YOU FOR YOUR HELP!
Lauralee Kiesel, Property Technician
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JEFFERSON COUNTY PERMIT CENTER
Andiugy)
APPLICAN° : 2 eu LL...►.■ eIS l L( _PHONE: 53) - 10 I 1
SITE ADDRESS: '4S-7 S ?O DATE: 10-(c.
P�=
��)HEALTH APPROVAL
SEPTI `ERMIT# SEP�g-
WATER FOOD SERVICE
2. SHORELINE
BANK HEIGHT
SETBACK
3. FLOOD ZONE
4. FOREST PRACTICE APP (CLA S )
5. PLANNING APPROVAL I
• &TICALAREA REVIEW 6 (p_-7.
ZONING J
8. HEIGHT
9. LOT COVERAGE
10. ADDRESS
11. FEE
12. NTRACTOR'S LICENSE aorviA2.1
13. ENERGY SHEET
14. BOND HOLDER/LENDER
15. NTT
16. SETBACKS
17. PROVIDE WA STATE ENGINEER STAMP/ARCHITECT'S STAMP
18. STORMWATER SITE PLAN
19. D.O.T. ACCESS APPROVAL
20. FIRE FLOW FOR COMMERCIAL STRUCTURES
21. PLAN REVIEW D3 ppy OCCUPANCY:
22. TYPE OF CONST:
23. EXPOSURE:
24. WIND:
25. SNOW:
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.