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Home My WebLink AboutBLD2006-00568 - CANCELLED THIS BUILDING IS NOT FINALED . THIS IS AN INCOMPLETE BUILDING APPLICATION . THE PERMIT WAS NEVER ISSUED . MLA06-00550 RILDING PERMIT APPLICATION Review Type:I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00568 Received Date: 10/3/2006 SITE ADDRESS: 1020 CARL JOHNSON RD QUILCENE, 98376 OWNER: TERRANCE RYAN PHONE: 6372 NE BARRETT DR POULSBO WA 983707701 SUBDIVISION: Block: Lot: T 8 PARCEL NUMBER: 701043016 Section: 4 Township: 27 N Range: 01 W CONTRACTOR: PHONE: PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI NSFR TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 400 VALUATION 61,181.00 ADD'L: 400 HEAT TYPE: EEE CODE EDITION: 2003 HEAT BASE: HEAT TYPE: OCCUPANCY: R-3 UNHEATED: #OF STORIES: OCCUPANCY: CONST TYPE: 5N OTHER: 280 SHORELINE: GARA CONST TYPE: DECKLE 100 SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: PWELL BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 1 Prop: 1 Total: 1 Total: 1 Routing Date: 101310(D Type Amount Paid By: Date: Receipt: Approved/Date Permit $727.75 LYK 10/03/06 85061 Plan Check $473.04 LYK 10/03/06 85061 State Building Code $4.50 LYK 10/03/06 85061 Potable Water Application $55.00 LYK 10/03/06 85061 Total: $1,260.29 • • ,i)ON c04 JEFFERSON COUNTY r� `l DEPARTMENT OF COMMUNITY DEVELOPMENT 'r ' `< 621 Sheridan Street• Port Townsend • Washington 98368 iti& 360/379-4450 • 360/379-4451 Fax www.co.jefferson.wa.us/commd evelopment ��hrx�s° (D 55_c) Master Permit Application MLA: 76 10/30 1G' Project Description(include separate sheets as necessary): /■4 Eii3 140 VA CZ IJc.eki Arlo t.J Tax Parcel Property Number. 70 1 0 43_0, (Iv Size: S: 4 3 (acres/square-Wet) Site Address and/or Directions to Property: (O Cpl. O4(i. S o(.) dan Qctf LC. Le N Property Owner(s)of Record:, T& (PA C_G t2:4A,1,1 Telephone: 3b0 -'1 6 5 o-1 rf ,_ Fax: email: Mailing Address: It,2.L7 CALL_ ;30}{OS5 fJ RP Qy.(I I-['aatJG kik 415516 Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies) Building ❑Variance(Minor,Major or Reasonable Economic Use) Uj Demolition Permit ❑Conditional Use(C(a),C(d),or C]** tgSingle Family ❑Discretionary"D"or Unnamed Use Classification 0 Garage Attached/Detached ❑Special Use(Essential Public Facilities)** ❑Manufactured Home 0Boundary Line Adjustment ❑Modular COShort Plat"* ❑Commercial* 0 Binding Site Plan** 0 Change of Use ❑Long Plat** ❑Address i Road Approach 0 Planned Rural Residential Development(PRRD)/Amendments** CI Propane Plat Vacation/Alteration** DAllowed"Yes"Use Consistency Analysis DShoreline Master Program Exemption/Permit Revisions*" ❑Stormwater Management DShoreline Management Substantial Development** ❑Site Plan Approval Advance Determination(SPAAD)* DShoreline Management Variance OTemporary Use ❑Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment ❑Forest Practices Act/Release of Six-Year Moratorium *May require a Pre—Application Conference **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 to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: 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 it's 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 wants prior notice. Signature: {- - _•_ r --r -- Date: 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-transferablle responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: �c / Date: f: ,�7�;; i D:\Permit-Center\FORMS\DRD FORMS\Master Permit Application 12-30-05-2.doc IIII • 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 ass_uning t e responsibility of the Ge eral Contractor for the proposed project. Signature] ic. �.—e- Date: /0/3/0 6 GENERAL CONTRACTOR OR MANUFACTURE ME INSTALLER: PHONE: FAX: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTORS LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) Fax:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: New X Wood Existing: 0 Sewer Addition ❑ Steel Proposed: 1 Bank ❑Community System ❑ Alteration/Remodel ❑ Concrete Total: / Height: E7 Individual Syste ❑ Repair El Masonry SEP Permit# $5-y(<1 ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: SE Private well 0 Two Party Type of Heat: Proposed: 1 ❑Public Total: ___i_ Name of System: 0 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: in Underground Tank ❑Above ground Tank Size of Propane Tank: 1=I Heat Stove ❑Cook Stove ❑Woodstove ❑Fireplace Insert ❑Hot Water Tank 0 Pellet Stove p 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 Current Proposed For Office Use Only Amount Revision Main Floor Heated EH Bld App Review: 'too GIte 2"0 Floor Heated t Consistency Review: OO ,( la _ X53. Other Heated Base fee: n -1 16. Mezzanine Additional Section: / 1. Heated Basement Plan Check fee: -413.01 Unheated Basement State Surcharge fee: •I 5° Other Unheated Pot Water Review fee: Q �o. Garage/Carport SUBTOTAL L5t 3 �Q Decks �� 911/Rd Approach fee:(60 3 Other — 2_b0 �t'56116° TOTAL: $ e� t'3 .2`� , Receipt Number: SS..-0/a ( iMpill 1 I D v) ash/Check Number: 2 -7 /� ESTIMATED COST(REQUIRED) Date: /v _ 3 --c) 6.Fair market value of all labor and materials foundation to finish v v<-/ Gvi) - OU Initials: p� D:\PetmitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05-2.doc ,L.� • • • \(-7)( '( )o6(L P okt) 114' d •! 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