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Home My WebLink AboutBLD2012-00336 THIS BUILDING IS NOT FINALED . THIS IS AN INCOMPLETE BUILDING APPLICATION . THE PERMIT WAS NEVER ISSUED . •ILDING PERMIT APPLICATOIN BLDI2-00336 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD12-00336 Received Date: 10/22/2012 SITE ADDRESS: 142 TIMBERLINE RD PORT TOWNSEND, 98368 OWNER: LEWIS D KOBETICH TRSTEE PHONE: 360-385-2792 CYNTHIA R KOBETICH TRSTEE PO BOX 67 CHIMACUM WA 98325-0067 SUBDIVISION: Block: Lot: TX7+ PARCEL NUMBER: 001204007 Section: 20 Township: 30 N Range: 01 W CONTRACTOR: KOZELISKY'S HOME SERVICE INC PHONE: (360)385-3215 31 HIDDEN TRAILS RD PORT TOWNSEND WA 98368 Contractor's License KOZELHS027C3 Expires 1/6/2013 REPRESENTATIVE: JAIME KOZELISKY PHONE: (360) 385-3215 31 HIDDEN TRAILS RD PORT TOWNSEND WA 98368 PROJECT DESCRIPTION DEMO EXIST. M/H TYPE OF WORK MOB SQUARE FOOTAGE: TYPE OF IMP DEM MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2009 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: _ o `22--1 a Type Amount Paid By: Date: Receipt: Approved/Date Permit $74.00 LYK 10/22/12 135330 State Building Code $4.50 LYK 10/22/12 135330 Total: $78.50 \\firlcmnr4 rin+n forme\C RI fl Ann Plrl rn+ 1(1/99/9(119 ,,e SON CQ • IECEOVED 4i t,, JEFFERSON'UNTY ' 1' DEPARTMENT OF COMMUNITY DEVELOPMENT'' 621 Sheridan Street• Port Townsend •Washington 98368 OCT 2 2 2012 360/379-4450 • 360/379-4451 Fax v O www.co.jefferson.wa.us/commdevelopment ' vv.. JEFFERSON COUNTY OF fOEVEtOPMENT ,,Master Permit Application MLA: 1� ,�"� 7 Projetct Description(include separate sheet as necessary): anD tsr. LTax Parcel NumberQO 12... % 007 Property Size: ` A C.ce S (acres/square feet) Site Address and/or Directions to Property: 1112. i ,,,bc 1 i,m.4, ?0 pc(21r -1-0L-e..)Ns NA Property Owner(s)of Record: 1 _ IRMAIRIMIL Telephone: 3 g$-- Z-] 9 Z Fax: email: Mailing Address: Applicant/Agent(if different from owner): J02■Mk_ ('cote t S k-vi Telephone: 3 5S- 3 Z i j Fax: - . 2 email:�� Mailing Address: 4; etc" 't S I �( ---Ti •EMI E i 3 6 it What kind of Permit?(Check each box that applies ❑Lot or Road Segregation ►.': ilding ❑Critical Areas Stewardship Plan ,'' Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family ❑Garage Attached/Detached ❑Conditional Use[C(a),C(d),or C]""'' ❑ Manufactured orne .❑ Modular ❑ Discretionary"D"or Unnamed Use Classification ❑ Commercial* ❑Special Use(Essential Public Facilities)** ❑ Change of Use ❑ Boundary Line Adjustment ❑ Address ❑ Road Approach_ ❑Short Plat** ❑ Home Business ❑Cottage Industry ❑Binding Site Plan** ❑Propane ❑Long Plat** ❑Sign - ❑ Planned Rurai Residential 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)* ❑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 ❑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., 1 -1(hE KbZ E-L' .r' l to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE ,._ r; i 7g` y Date: JO / 2 — / 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 any required later inspections. Staff's access and right of entry will be assumed unless the applicant informs the County in writing at the time of the applicatioithat he or he wanti prior notice. \Signature: - Vi"--12- ' 9 ( Date: I O — I Z f Z— 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_responsi ility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. �>:Signature: 8,ltkt . IV°-j� Date: /D CZ 1- ' _._ ., ,,,........�iaiau ,.,,,..-.-,,,,.•� r------•non r..,..Y_��.r n,.__.:.a...., c 10 nQ.L.,. ..' . • • 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 tfie responsibility of the General Contractor for the proposed project. - _ Date: _SiGEN@RAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAx: ikt2e. Vs 'S J--e vie c u �- _ (?�t;o) �- 2 13 (aka 3 g -12 i�" MAILING ADDRESS: 1 /4 c A A.,-..\ }S c' tS 1�� EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAx:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: 0 Shoreline: Type of Sewage Disposal: ❑ New Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: _ Height: Individual Syst. qj�o ❑ Repair ❑ Masonry SEP Permit# C`'►–(. 10 Bedrooms: Water Supply: Demolition ❑ Other: reExistin g: Setback: Private well ❑ Two Party Type of Heat: Proposed: o Public k \t �z ft Total: 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: 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 1 Pellet Stove 1 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. Square Footage [urrent Proposed For Office the 00,1y Amount Revision Main Floor Heated EH Bld App Review: na Consistency Review: , 2 Floor Heated Other Heated Base fee: .7A1 ,- — — Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: /j ` ", Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: $ I C)1---1-,Tip Receipt Number: 1 333 Cash/Check Number: ESTIMATED COST(REQUIRED) Date: •Fair market value of all labor and materials foundation to finish Initials: 1 C 1) 1' O . 74 m 1 N. a -1 m .v 'r1 g ♦' _, _. i M •r „ �j Z • yn., -, - - r7 . , . I , ,, !, ,_ cif M> • , , 1 v CO N f� ' 1 f / • 't7 1 Ci c i a..., .N -- . „ . . E . - j'' ' Iv .r...... ., �, _ m -T • m7 17 7-1 r \ r Fri ,- 0 v ?, ;Ti a v v rn . 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