HomeMy WebLinkAboutBLD2008-00391 THIS BUILDING IS
NOT FINALED .
THIS IS AN INCOMPLETE
BUILDING APPLICATION . THE
PERMIT WAS NEVER ISSUED .
UILDING PERMIT APPLICA•N BRDiewType: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD08-00391 Received Date: 8/29/2008
SITE ADDRESS: 1063 S POINT RD
PORT LUDLOW, 98365
OWNER: MARY JANE DONALDSON PHONE:
1063 SOUTH POINT RD
PORT LUDLOW WA 98365
SUBDIVISION: Block: Lot: 2
PARCEL NUMBER: 721043004 Section: 4 Township: 27 N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: ALAN DONALDSON PHONE:425-941-5373
110 110TH AVE NE
SUITE 370
t
PROJECT DESCRIPTIOP ROOF REPLACEMENT, PITCH CHANGE &ADD SF SEMI HTD
ATTIC STORAGE
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP ALT MAIN:
VALUATION 30,000.00 ADD'L: HEAT TYPE: SEMI
CODE EDITION: 2006 HEAT BASE: HEAT TYPE:
OCCUPANCY: R-3 UNHEATED: #OF STORIES:
OCCUPANCY:
OTHER:
CONST TYPE: 5N GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: PWELL
BEDROOMS: BATHROOMS:
Exist: 1 Exist: 1
Prop: 0 Prop: 0
Total: 1 Total: 1
Routing Date:
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $441.75 LYK 08/29/08 102562
Plan Check $287.14 LYK 08/29/08 102562
State Building Code $4.50 LYK 08/29/08 102562
Total: $733.39
PA1 19,1 RODS
4� oN cQ JEFFERSO UNTY
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44 DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street• Port Townsend •Washiington 98368
k. 360/379-4450 . 360/379-4451 Fax
Q$$ a$ www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: YYk ,. 0-4r--,)-1
Project Description (include separate sheets as necessary):.-y 1,_ r 10,U j- /) c t&r QCIc
//�� 1-hod A t�� s+or
_ Tax Parcel Number: 77- I ' 4/3 00 Property Size: fin.9�a-c ((acres/square feet)
Site Address and/or Directions to Property: /p 6j s $'� o7b1 f- 1 "J '7,r
� -}- 1 a�
Property Owner(s)of Record: Lf7:fs.'M ' '1'►", 4s-1-'
Telephone: Fax: D / email:
Mailing Address: /o6S S Paint (ter t i l�.44 io r4-, I'"�' 4715:7;34.5
Applicant/Agent(if different from owner): f £ �AHdf t Sol— �.fon °4: RNA/f AA)
Telephone: 42-6-W/-5'r-73 Fax:442-f=6fg-77 67 email:
Mailing Address: / n a :/1 fu;tR- ° r' //2/ W,4- '$O
What kind of Permit?(Check each box that applies
•uilding ❑ Critical Areas Stewardship Plan
❑ Demolition Permit ❑Variance(Minor, Maier or Reasonable Economic Use)
J%Single Family ❑Garage Attached/Detached ❑Conditional Use[C(a),C(d),or CJ**
❑ Manufactured Home ❑ Modular ❑ Discretionary°D"or UnnanfedlUSe Classification-
❑ Commercial* ❑Special Use(Essential Public Facilities)**
❑ Change of Use ❑ Boundary Line Adjustment AUG 29 2008
❑ Address ❑ Road Approach ❑Short Plat** --�
❑Home Business ❑Cottage Industry ❑ Binding Site Plan**
❑Propane ❑ Long Plat**
❑Sign ❑Planned Rural 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 id� �jtify any other local,state,pr fede al permits re uire for this proposal, if known: cv/ie hd/.e I"
;H ,.&'$'1%J' td Ca/b L1�utt,I.z k 41i t-f/iar'Q an dW (a,4',at a/ direr/tw►ekdwtS H1.0A f"'
A/ �) t_/s DESIGNATION OF AGENT
I hereby designate/`T(4i.H 7a/`�"�/L('J�#-at---""
--"" to�act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE / id ' X C94 Ce4— 41 Date: 05 67-te"'
By signing this application fo 'the,, er/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. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the application that he or she warjts prior notice. t? 11-1' I
Signature: Date:
The action or action App nt 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"r'espopsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: "Ma e/ l�l r"�r_tQ. of Date: 0 g /1/1°[/ O lJ'
G:\PemvtCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc
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BUILDER STATEMENT
1
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 assu.•' . .- res ten 'bility of the General Contractor for the proposed project. ,
Signature: /. Date: a �/ �- z-J
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
( ) ( )
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE
( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
Li New )(Wood Existing: 1 ❑ Sewer
.. Addition ❑ Steel Proposed: c7 Bank ❑ Community System
El Alteration/Remodel n Concrete Total: 1 Height: JS( Individual System
gRepair ❑ Masonry SEP Permit# 70—2-8
C Demolition ❑ Other: Bedrooms: Water Supply:
Existing: I Setback: Private well ❑ Two Part
Type of Heat: Proposed: C �`�` Public y
Total: i 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:
I 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 I Pellet Stove I 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 Foota e Current Proposed For Office Use Only Ainot nt' Revision, °
Main Floor Heate (��' �f S• EH Bid App Review:
u +5(?S r dt cfh r�iC a: 70
Floor Heated
(g+c{1;•., etifrc, S Vita Al/4— ���.�f q : Consistency Review:
Other Heated Base•fee: I R
Mezzanine
0,2 ��I/r • „ i Additional Section:
if Heated Basement (rf " _ M
ii/ft /t- ' r Plan Check fee: (LI
Unheated Basement /r /A /I ,4 State Surcharge fee:
Other Unheated Pot Water Review fee:
rJ.�r,� t� OA
Garage/Carport ✓/� /� SUBTOTAL .F( -5
Decks
911/Rd Approach fee: �,`�
Other R11�
TOTAL: $ e-i
Receipt Number: Ia_.
Cash/Check Number 3) (Ori
STIMATED COST - P IRED) Date:
•Fair mat value of all labor an• •-tenets foundation to finish, al Ai
_`. _ . 0 0 0 Initials:
VP' �,�
—
G:\PemutCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc
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