HomeMy WebLinkAboutBLD1995-00373 JEFFERSON COUNTY BUILDING APPLICATION
Jefferson County Permit Center
Castle Hill Mall
621 Sheridan St.
Port Townsend, WA 98368
360-379-4450
PERMIT # •BLD95-0373 DATE RECEIVED. : 06/30/95
SITE ADDRESS: 631 MONTGOMERY LN
:PORT LUDLOW, WA 98365
APPLICANT. . . :JOHN RESECK PHONE: 437-0351
MAILING ADDR: 631 MONTGOMERY LANE
:PORT LUDLOW WA 98365
CONTRACTOR. . : PHONE:
MAILING ADDR:
•
CONTR. LIC #: EXPIRATION DATE: / /
ARCHITECT/ . . : PHONE:
DESIGNER
MAILING ADDR:
PARCEL NO. . . : 990400253 ALT: CON :
LEGAL DESC. . : STR EWM, TAX # BY: —PTA- DATE:
LOT 53 , BLOCK , PORT LUDLOW #1
WATER: 1, 171 DATE:
CAR : DATE: -1/5-/c_
DESCRIPTION OF IMPROVEMENT: repair deck
BUILDING TYPE •RES BEDROOMS--- BATHROOMS-- MAIN FL. . . : 0 sf
TYPE OF IMPROVEMENT:REP EXIST. : 0 EXIST. : 0 ADD'L FL. . : 0 sf
GARAGE/CARPORT PROP. . : 0 PROP. . : 0 HTED BSMT. : 0 sf
WOODSTOVE • TOTAL. : 0 TOTAL. : 0 UNHT BSMT. : 0 sf
UBC OCCUPANCY GROUP: SEWAGE DISP. . : SEi,i.. OTHER 0 sf
TYPE OF CONST WATER SUPPLY. :LUDLOW CRPT/GAR. . : 220 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. $: 2200 SIZE: BANK HT. . . : 0 ft
PROJ GRP. . : 6557 SH SETBACK: 0 ft
Owner/agent `` FEES
Signature: type amount by date recpt
PRMT $ 54 . 00 MTM 06/30/95 107481
Date: s �• � PLCK $ 16 . 20 MTM 06/30/95 107481
B.C. $ 4 . 50 MTM 06/30/95 107481
Issued By / ,! ", ,A
Date: & Building Depart€mcflt
$ 74 . 70 TOTAL
JEFFERSON COUNTY BUILDING PERMIT
Jefferson County Permit Center
Castle Hill Mall
621 Sheridan St.
Port Townsend, WA 98368
360-379-4450
PERMIT # •BLD95-0373 DATE ISSUED. : 07/05/95
SITE ADDRESS: 631 MONTGOMERY LN
:PORT LUDLOW, WA 98365
APPLICANT. . . :JOHN RESECK PHONE: 437-0351
MAILING ADDR: 631 MONTGOMERY LANE
:PORT LUDLOW WA 98365
CONTRACTOR. . : PHONE:
MAILING ADDR:
CONTR. LIC #: EXPIRATION DATE: / /
LOAN LENDER. :
MAILING ADDR:
•
PARCEL NO. . . : 990400253
LEGAL DESC. . : STR EWM, TAX #
LOT 53 , BLOCK , PORT LUDLOW #1
DESCRIPTION OF IMPROVEMENT: repair deck
( +-)--looting/Setbacks (Shoreline Setback) :
ok 1-\ 5 s bey
( (4-Toundation:
( ) Underground Plumbing/Underground Insulation:
4 Fr. n lumbing/Chimney:
( ) Insulation:
( ) Sheetrock:
( 14' Final/Occupancy Approval: o-- - L ' t
THIS PERMIT IS VALID FOR ONE YEAR.
24 Hour Recorder for Inspections
CALL 379-4455 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS
Office Hours 9 a.m. to 4 : 30 p.m.
Inspector's Phone Hours 8 - 9 a.m.
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Jefferson County Permit Center evvg a"L J Date
621 Sheridan Street d Fee
Port Townsend WA 98368 Rec #
CRITICAL AREAS QUESTIONNAIRE Ck #
Case #
Applicant Name h SL c/�
Building Application Land Use Application _ Shoreline Application
On-site Sewage Application Subdivision Application Other:
pi
1 . Is there any standing or running water on the surface of the YES
property or on any nearby property at any time during the year?
If YES, please describe:
2. Has any portion of the property or any nearby property ever been YES (-RO\\
identified as a wetland or swamp?
If YES, please describe:
3. Are any willows, skunk cabbage, alders, or cottonwoods present � Y t ` 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 0
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 o ❑
I r / r
r r r /
II I I
r r r r r i , ,.❑
r r r
r r r r / / , • ❑
r r r r / / / ,/
r r r r / / . , ,
r r r r i / i , ,
-❑
r iii
, .
I I,,,i/ ,1' ,' .❑
III / r , , ,,,, ,//
lar rrrrrr , , ,'
rrrrrii /,' .' .�
--0
rrrrri,,,
(Questionnaire Continues on Back)
6. Does the site have steep slopes with little to no vegetation? YES ___
CV
If YES, please describe:
7. Does the site contain high percentages of silt and/or very fine YES QN
sand?
If YES, please describe:
8. Does the site contain ground water seepage or springs near the YES
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 Oi,,,4://75—
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:
*JEFFERSON COUNTY BUILDING PERMIT APPLICATION
BUILDING TYPE IMPROVEMENT TYPE
❑ SINGLE FAMILY ❑ NEW BUILDING
❑ MOBILE ❑ ADDITION 500+1500-
❑ MODULAR ❑ ALTERATION
❑ GARAGE ATTACHED/DETACHED .d REPAIR
❑ WOODSTOVE ❑ DEMOLITION
❑ MULTI-FAMILY/UNITS ❑ RELOCATION
❑ COMMERCIAL
❑ INDUSTRIAL
❑ HOTEL/MOTEL/DORM/UNITS ,
OTHER„1";G c, i . UBC OCCUPANCY GROUP
DESCRIPTION OF IMPROVEMENT: 2Rela t r SI d d ec k 5rr/V11 C_ ,o t(# (LY1
SQUARE FOOTAGE PRINCIPLE TYPE OF HEATING FUEL
MAIN FLOOR ELECTRICITY ❑ OIL
2ND FLOOR ❑ WOODSTOVE ❑ GAS
3RD FLOOR ❑ HEAT PUMP ❑ OTHER
HTD BASEMENT
UNHTD BASEMENT
CARPORT PRINCIPLE TYPE OF FRAME
GARAGE
DECKS6 r5if WOOD ❑ MASONRY
COMMERCIAL ❑ MANUFACTURED ❑ OTHER
INDUSTRIAL ❑ STRUCTURAL STEEL
OTHER
TOTAL VALUATION
or
ESTIMATED COST Lao MAXIMUM HEIGHT
❑ INSTALLED 19
TYPE OF SEWAGE DISPOSAL: )(SEWER ❑ SEPTIC SYSTEM
'� tM SEPTIC PERMIT NUMBER
TYPE OF WATER SUPPLY: PRIVATE ❑ DRILLED WELL OTHER
PUBLIC ❑ CITY OTHER: NAME
,•K PUD STATE I.D.
NUMBER OF EXISTING BEDROOMS _ NUMBER OF EXISTING BATHROOMS
NUMBER OF PROPOSED BEDROOMS (2) NUMBER OF PROPOSED BATHROOMS (a
TOTAL NUMBER OF BEDROOMS �3
� TOTAL NUMBER OF BATHROOMS
IF WATERFRONT PROPERTY NAME OF ADJACENT BODY OF WATER
BANK HEIGHT SETBACK
FRONT SETBACK SIDE SETBAC S / 6/3/?-5—
REAR SETBACK
SIGNATURE- e /�''( DATE
APPLICAN E (PLEASE PRINT) �/p HA/ g/I j� T� .
FOR OFFICE USE ONLY
TYPE OF ACCESS RD .
❑ Primary Arterial ❑ Secondary Arterial ❑ Collector ❑ Access
FOOTPRINT (incl decks over 30" from ground)
LOT COVERAGE (footprint divided by total
sq ft of property)
BASE FEE 5)-/- /
PLAN CHECK 1 •0 a0 /• RECEIPT # �g
STATE SURCHARGE 4.50 DATE i gym_
RADON KIT .311=r—
TOTAL 74, 10 ,
CASH/CHECK # I A
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