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Home My WebLink AboutBLD2013-00028 BUILDING PERMIT APPLIION BLD13-00028 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD13-00028 Received Date: 1/23/2013 SITE ADDRESS: 32 NAVIGATOR LN PORT LUDLOW, 98365 OWNER: JESS SCHEFSTROM PHONE: 503-410-4568 MARY C SCHEFSTROM 32 NAVIGATOR LN PORT LUDLOW WA 98365-9614 PORT LUDLOW NO. 2 SUBDIVISION: Block: Lot: 208 PARCEL NUMBER: 990603208 Section: 9 Township: 28 N Range: 01 E CONTRACTOR: AIR FLO HEATING COMPANY INC PHONE: 360-683-3901 221 W CEDAR SEQUIM WA 98382 Contractor's License AIRFLI*206DG Expires 4/25/2014 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr HEAT PUMP TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION 10,037.00 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: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $228.00 LYK 01/23/13 139932 APPROVED Total: $228.00 JAN 2 3 2013 Jefferson County DCD Mir4cmor4\rin+nkfnrmclG RI Il Ann PIA rn+ 1/92/9!194 cod,. JEFFEOON COUNTY II i r `4` DEPARTMENT OF COMMUNITY DEVELOPMENT .\ { -, *d 621 Sheridan Street• Port Townsend •Washington 98368 ti 360/379-4450 • 360/379-4451 Fax www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: no ra ,,„...„,„ Project Description(include separate sheets as necessary): Tax Parcel Number. qO%0(90 32,04A Property Size: (acres/square feet) Site Address and/or Directions to Property: 32 N av: .alror- Lane), Port .\f•)4 �i 3W S Property Owner(s)of Record: eSS M. . _ - k OM Telephone: 50 3 - 4-II 0 * ''t 5 Lrr' Fax: email: Mailing Address: 3 Max.)•i a11,Yr .ace. ►. Po f t ls.kcilssw t..)fl ok‘3112s , Applicant/Agent(if different from owner): et tr tO 'r\e.2.'r vc' Telephone: 3t4..„0-Csicb3'?t %0 1 Fax: 1.453- ZGI-1 1 email:eklGf"( atrktdhe2'hne. ' Mailing Address: <901 Y i . Cedar S r ,Seau./.r r %38-> cow. What kind of Permit?(Check each box that applies ❑Building 0 Critical Areas Stewardship Plan Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use) bi Single Family ❑Garage Attached.[Detached ❑Conditional Use[C(a),C(d),or C)" ❑ Manufactured Home ❑ 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 0 Cottage Industry ❑Bi • ` ❑Propane Lo 1C n ❑Sign ❑Pia n d -• - -:1- 1- •-ve••—, i• '-s)/Amendments'" ❑Allowed"Yes"Use Consistency Analysis ❑Pla Vacation/Alteration"" ❑Stormwater Management ❑S Me Mast r psoglpart at.•tio ja t Revisions""❑Site Plan Approval Advance Determination(SPAAD)" ❑S r ine Manfi bnierft S(ib'�- al D •ment"" ❑Temporary Use ❑ShOrrinie Management Variance ❑Wireless Telecommunication* ❑Corhpreh istri« Map Amendment ❑Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson Coun titi6iiiii4likater Progra Amendment "May require a Prey Application Conference ❑Tree Vege s''.de -riii*iiiJ'FL' _OPft^FNT '"`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 I fit l la- to act as my agent in matters relating to this pplication for permit(s). OWNER SIGNATURE All/ ��js� Date: By signing this ap•ar •n form,the ownerfagent attests that the information provided herein,and in any attachments,is true nd correct to the best of his,her or its kn. :•ge. 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 prey'.e access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any re. <• later inspections. S 's a--•- an• righ • entry will be assumed unless the applicant info s the County in writing at the time of the appl'•-• o that he or she wan for no,/. I „ - Signature: i 4 -....., / � Date: / Al The action or: •ns Applicant will undertake as a -ult of the issuance of this permit may negatively impact upon one or more threatened or endange =• • ..-es and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the "Endangere. pecies 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(? even if.., re in Cor!+n .antis a C £ .`-•;� g pre. °, 1c:k1ic-mledyje8 that lie,eh.,ur i•=ids ind.vicuai ) !lance the.! *r;r.- ,„¢��.• its(•?:,,.• -4y e s �; and non-transfer a responsibility fo Sheri • o and• ng with the ESA. The Applicant has read this disclaime and dates it below. Signature: A ��i�./ Date: l//S .j/? dr G:\PernitCenter\###FOAMS###\DRD FORMS\Master Permit.Application 5-29-O8.doc 1 0 • w 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 the responsibility of the General Contractor for the proposed project. Signature: Date: • "-. QNTRACTOR. PHONE: FAX P%.& FL-0 NSttkOC,•• ( )3d5—S3S Itt ( )6t 3-311 1 MAILING ADDRESS: fj •IRK- 0 ■ FrMAIL CONTRACTOR'S LICENSE WAINS NUMBER: a,R FL l' k D NUMBER ARCHTTECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: • EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System X Aiteration/Remodel ❑ Concrete . Total: Height: ❑ Individual System ❑ .Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat Proposed: ❑ Public Total: Name of System: If this is a Commercia[Prolect YOU must answerthe fotiowino: 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 Proeane Tank and/or Appliance Installation permit,mark all items below that apply: t Underground Tank t Above ground Tank Size of Propane Tank: I Heat Stove i Cook Stove I Woodstove 1 Fireplace Insert I Hot Water Tank I Pellet Stove t Other Is this appliance being installed In a Manufactu I Mobile Home? Yes / No When app!ying fora 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, lncludin! the reserve area S•uare Foote!a Current P •••sect ' r P t sue. ,,:�f !!_ , Main Floor Heated EH Bid App Review: , 263 Floor Heated Consistency Review: Other Heated , Base fee: (9:98' {� Mezzanine Additional Section: Heated Basement f _ t ' Plan Check fee: Unheated Basement ; ? '- State Surcharge fee: Other Unheated • f, ' + ' Pot Water Review fee: Garage/Carport 4, s SUBTOTAL Decks ;a 911/Rd Approach fee: Other � 4 '.A - + r lu TOTAL: $c. Receipt Number. t- CashlCheck Number: �J3 ESTIMATED COST(REQUIRED) Date: 'Felt*market value of all labor and materials foundation to Meth tlf, 1O 0-6'1• 00 Initials: (-- GAPerrnitCrnaer\###FORMS###\DRD FORMS\lvlaater Peonit Application 5-29-OS.doc 1 MECHANICAL AND DEMOLITION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD13-00028 Received Date 1/23/2013 SITE ADDRESS: 32 NAVIGATOR LN Issue Date 1/23/2013 PORT LUDLOW, 98365 APPLICANT: JESS SCHEFSTROM PHONE: 503-410-4568 MARY C SCHEFSTROM 32 NAVIGATOR LN PORT LUDLOW WA 98365-9614 208 SUBDIVISION: PORT LUDLOW NO. 2 Block: Lot: PARCEL NUMBER: 990603208 Section: 9 Township: 28N Range: 01 E CONTRACTOR: AIR FLO HEATING COMPANY INC PHONE: 360-683-3901 221 W CEDAR SEQUIM WA 98382 Contractor's License AIRFLI*206DG Expires 4/25/2014 OWNER, JESS SCHEFSTROM PHONE: 503-410-4568 if different: MARY C SCHEFSTROM 32 NAVIGATOR LN PORT LUDLOW WA 98365-9614 PROJECT DESCRIPTION: HEAT PUMP Directions To Site: THIS PERMIT IS VALID FOR ONE YEAR AND IS NOT RENEWABLE. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 1/23/2014. REQUIRED INSPECTIONS: ,Vt-4l rum(' / ()e l ,,,/;4 3 1/� FinalApproval: Ott /z/ //4'.5 4/ BUILDING INSPECTION HOT-LINE 379-4455. REQUESTS MUST BE RECEIVED BY 3 PM THE DAY BEFORE THE INSPECTION IS NEEDED. Office Hours 9:00 a.m. -4:30 p.m. Monday-Thursday HOT LINE AVAILABLE 24 HOURS A DAY \\tidemark\data\forms\F_BLD_Permit_Propane.rpt 1/23/2013