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HomeMy WebLinkAboutBLD2008-00086 THIS BUILDING IS NOT FINALED . THIS IS AN INCOMPLETE BUILDING APPLICATION . THE PERMIT WAS NEVER ISSUED . Review T Ty 091 •ILDING I.PERMIT APPLICAT ML ype: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD08-00086 Received Date: 2/28/2008 SITE ADDRESS: -�( SIERRA TRAIL QUILCENE, 98376 OWNER: GREG ELKERTON PHONE: 206-720-1934 PATRICIA KELLY 1131 32ND AVE SEATTLE WA 981225120 TAX 26 SUBDIVISION: Block: Lot: PARCEL NUMBER: 601324008 Section: 32 Township: 26 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTION NEW CABIN - CONSTRUCTED W/O PERMIT (COM07-128) TYPE OF WORK RES SQUARE FOOTAGE TYPE OF IMP NEW MAIN: 192 VALUATION 30,000.00 ADD'L: 85 HEAT TYPE: CODE EDITION: 2006 HEAT BASE: HEAT TYPE: OCCUPANCY: R-3 UNHEATED: # OF STORIES: OCCUPANCY: CONST TYPE: 5N OTHER: 21 SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: 267 BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: 2WELL BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 1 Prop: 1 Total: 1 Total: 1 Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $441.75 LYK 02/28/08 95933 Plan Check $287.14 LYK 02/28/08 95933 State Building Code $4.50 LYK 02/28/08 95933 Potable Water Application $59.00 LYK 02/28/08 95933 Total: $792.39 •• • • MAR 0.3 2068 JEFFERSON COUNTY D•CD • • • • il. 1 (4, • t.4 1 0 . rrV!• - 4 1�' �tL0 OIL . _. ....., . ... d .? . �h • �,.iCi ? • i 4, O. • • it �5 Ct' a i a:,y g/ I 'll ,tar at eiel t.-- i 1 • \niiv'bavdt, . • • CAAtki . wt1II, , I • • 1 FL-00g. p2..A C„,F r RE C E I A rF'9 ' air c.{:5�� JEFFERSON C; F ITY , , 'i DEPARTMENT OF• COMMUNITY DEVELOPMENT FEB 2 8 2008 I' •N , `'4 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 •• 360/379-4451 Fax 4q,S 0s0 www.co.jefferson.wa.us/commdevelopment JEFFERSO}V COUNTY Master Permit Application • MLA: (�' ' Project Description (include separate she is as necessary): El1LErc-roe4 she SUL U caw ,/G /N Tax Parcel / Property Number: `0 f 3 2_ 10 0 I S Size: (CIL/square feet) Site Address and/or Directions to Property: ( 4,1 r II2w . i4. 4 eldr,s I) S',ct cra `(`rc ( , 61.14lc2-1LQ- W A 9 S31 1, (N CO/l4) Property Owner(s)of Record: �rel E I L.-4- o _ i ` 1. I( I Telephone: 2 Oi . -12-c-f 1114 Fax: it.,G - 16 t 3 4 7 I email: ccj�cal t Mailing Address: t III - 3 .. AA,,� J ©Z'+`e i �fit;l� , ihl/� � S r 2Z Applicant/Agent(if different from owner): Telephone: Fax: Mailing Address: email: What kind of Permit? (Check each box that applies Building 0 Variance(Minor, Major or Reasonable Economic Use) Demolition Permit 0 Conditional Use[C(a),C(d),or C]** X Single Family( 4Ui&) 0 Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home 0 Modular 0 Special Use(Essential Public Facilities)** ❑ Commercial* 0 Boundary Line Adjustment ❑ Change of Use ❑Short Plat** ❑ Address 0 Road Approach 0 Binding Site Plan** ❑ Home Business ❑ Cottagelndustry 0 Long Plat** ❑ Propane 0 Planned Rural Residential Development(PRRD)/Amendments** ❑Sign 0 Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions** ❑Stormwater Management 0 Shoreline Management Substantial Development** ❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Variance ❑Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* 0 Jefferson County Shoreline Master Program Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium *May require a Pre—Application Conference ❑Tree Vegetaion Request Pre-Applition Conference Please identify any other local, state or federal permits required for this aproposal, if known: I hereby designate DESIGNATION OF AGENT 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 inspecti ns. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the application that Mgr sh ants prior notice. Signature: �"')7 (_-- Date: 2 /� 6' 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 lake"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-transferabll.respo ' 'ity for dhering to and complying with the ESA. The Applicant has read this disclaimer and Si ns and dates it below. Signature: �� Date: -2/f g/0 Y — 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 he General Contractor for the proposed project. Signature: Date: 2-0/ GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTORS LICENSE WAINS .; j • NUMBER: .t .4 A . . t: I' i) UMBER ; \ .t', ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: YP Frame T e: Bathrooms: Shoreline: Type of Sewage Disposal: .� ❑ Sewer o New Wood Existing: z Bank ❑ Community System 0 Addition 0 Steel Proposed: Total: Height: ) Individual System O Alteration/Remodel 0 Concrete t y OC SEP Permit# 9� �'. �3 8 a ❑ Repair 0 Masonry O Demolition 0 Other: Bedrooms: Water Supply: Existing: i Setback: ❑ Private well Two Party Proposed: S tit? ' 0 Public Type of Heat: Total: __L— Name of System: If this is a Commercial Project you must answer the following: N to Number of ADA Parking Spaces: Number of Parking Spaces: Current: Proposed: Proposed Number of occupants(includes owners,tenants,employees,etc) Current Will you have Food Service? Yes / No IBC Occupancy: IBC Type of construction: If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: 1 Underground Tank 1 Above ground Tank Size of Propane Tank: 1 Heat Stove 1 Cook Stove 1 Woodstove 1 Fireplace Insert 1 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. , • , * E t ",t' �"''^"+ g y a�,. r %` 4 Y ,�� ,y_s.ill.�� �•� � �..� r°r r� �?s;is Square Footage 1 Current Proposed jflr�1,ll "1 O11 �- Main Floor Heated -�-�� EH Bid App Review. pu leo- 2" lied � ;,, Consistency Review: oxp S � I � Other Heated ,P_-=` . Base fee: �'i li I �- N .ti Additional Section: Mezzanine Heated Basement ,,• Plan Check fee: Unheated Basement 4�1='.,'" State Surcharge fee: Other Uphepted 3x v Pot Water Review fee: C� Garage/Carport r I *'a SUBTOTAL - q Decks 1/ �n (ok) 44 . ; 911/Rd Approach fee: J uJ .r (0 Other ` PI , t`-. `'14 TOTAL: nett; } #:�;;��~1 Receipt Number: °13g33 v io f Cash/Check Number: r j g ESTIMATED COST(REQUIRED) - -- Date: '-1_�c� CIS •Fair market value of U_tabor materials foundation to finish Initials: ,c�_�f`-- 6_ 4361000 —---) G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc . • z KN` V a-•- ti • r. _ r - Ip "._ —n O 0 \- z I m FI 9 4 _Al �.I i r, 1 o N., 1 4, I 4 E 1 ........-17, [ vi ',, t -1 c ,----,.• n 1i* \\\,_,'' '1 V 1 A mi- ¢` z _ o a "L (11 0 NV . , L. r . r • -4. . 1- . - - I • 4.— r-r-t -N--, ,...,-, 0.4.-1 -11 LA m 4.3-4 co C=5 n t. Lt c:=5 00 ZIM N3 c=1 co CO 1=3, C=I tj 11 - . ___—....., 0 elr c. 4 :1 (" 14 r Pi Al? 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