HomeMy WebLinkAboutBLD2008-00158 THIS BUILDING IS
NOT FINALED .
THIS IS AN INCOMPLETE
BUILDING APPLICATION . THE
PERMIT WAS NEVER ISSUED .
UILDING PERMIT APPLICAIN MLLA08-001196
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
•
PERMIT #: BLD08-00158 Received Date: 4/22/2008
SITE ADDRESS: 2715 E MARROWSTONE RD
NORDLAND, 98358
OWNER: JOHN R PATE PHONE: (360) 385-7596
CANDICE J COLE
2715 E MARROWSTONE RD
NORDLAND WA 98358-9520
SUBDIVISION: Block: Lot: TX 74
PARCEL NUMBER: 021332003 Section: 33 Township: 30 N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI NEW SFR
ALSO AIG 250 GAL PROPANE TANK
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 1,530
VALUATION 125,000.00 ADD'L: HEAT TYPE: RAD
CODE EDITION: 2006 HEAT BASE: HEAT TYPE: PRO
OCCUPANCY: R-3 UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: 5N GARAGE: SHORELINE:
CONST TYPE: SETBACK:
DECK: 426
BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM: PWELL
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: 2 Prop: 2
Total: 2 Total: 2
Routing Date:
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $1,133.75 KAS 04/22/08 97325
Plan Check $736.94 KAS 04/22/08 97325
State Building Code $4.50 KAS 04/22/08 97325
Potable Water Application $59.00 KAS 04/22/08 97325
Total: $1,934.19
ON •
eOj, JEFFERSO OUNTY
t.:"51.
I i DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street • Port Townsend •Washington 98368 APR 2 2 2008
360/379-4450 • 360/379-4451 Fax
.q�, NG�c3 www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: 0e)— i.CIIP
Project Description (include separate sheets as necessary): *
filet.•% :stnj1C_, I'P,5ic�A4 (Pr ( GL}Y15)'rti'6.1l ovi
Tax Parcel 021 33� t3 Property
Number: Size: 7oj(200 6f. (acres/square feet)
Site Address and/or Directions to Property:
/7-7141.51-e V fo `� �o t.mc r!u uJ5Jc 1 r
2"1 is e AR KR_l9iJ5 /] /id • 10d (wol Ifry1 f a/ft eir'3 s"<S'
Property Owner(s)of Record: zeh n R. Po r'L , �iRYI Iic2 ('a j€..-
Telephone: 3!'00 385 7$5! Fax: 'i email: .J)'-V1d CC-G(9 ikipo'rt,c:Nr1
Mailing Address: a7/6- ,_- A11Piln.4)6./v'le. Re Akre / ttiY4 gR3SA"
Applicant/Agent(if different from owner): i�AA
Telephone: ah: email:
Mailing Address:
What kind of Permit? (Check each box that applies
fi6Building ❑Variance(Minor, Major or Reasonable Economic Use)
❑ Demolition Permit ❑ Conditional Use[C(a),C(d),or C]**
'Single Family ❑ Garage Attached/Detached 0 Discretionary MD"or Unnamed Use Classification
❑ Manufactured Home ❑ Modular ❑ Special Use(Essential Public Facilities)**
❑ Commercial* ❑ Boundary Line Adjustment
❑ Change of Use ❑ Short Plat**
❑ Address ❑ Road Approach ❑ Binding Site Plan**
❑ Home Business ❑Cottagelndustry ❑ Long Plat**
( Propane ❑ Planned Rural Residential Development(PRRD)/Amendments**
❑ Sign ❑ Plat Vacation/Alteration**
❑Allowed "Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions**
❑Stormwater Management ❑ Shoreline Management Substantial Development**
❑ Site Plan Approval Advance Determination (SPAAD)* ❑ Shoreline Management Variance
O Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment
❑ Forest Practices Act/Release of SixYear-Moratorium- - ❑-Tree Vegetaion Request
*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:
IvA-
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 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 -e ired later inspections. Staffs access and right of entry will be assumed unless the applicant informs the Co my in writing at the
time of the a.•lica 'on hat he or sh4 ant�f or no e.
Signature: >`s, Date: 0 ,,,
The aclefl 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-tr. sf-rabl-responsib'•I, for a. _ring t/nd complying with the ESA. The Applicant has read this disclairrier an signs and dales it below.
Signature: /- Ai./ ' _ -- Date: 9 i //((5
i
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc
• BUILDER STATEMENT •
The signer of this statement does hereby ce ' that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that
they will be assui g t - responsi•i of th G neral ontractor for the proposed project. /� t
Signature: A tt L Al i I : 0 Date:
GENER•■ ONTRACTOR 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:
VrNew C"Wood Existing: 0 MA ❑ Sewer
❑ Addition 0 Steel Proposed: :z Bank ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: 2. Height: l Individual System
❑ Repair ❑ Masonry SEP Permit# 9$-OO ct
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: 0 Setback: IR' Private well ❑ Two Party
Type of Heat: Proposed: 2 ❑ Public
rat iri] J Total: 2. 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:
1 Underground Tank Above • • •• -• Size of Propane Tank: 2_S0 /
1 Heat Stove ook Stove 1 Woodstove i Fireplace Insert 1 Hot Water Ta 1 Pellet Stove i OtherPe le S4 "- .
Is this appliance being installed in a Manufactured!Mobile Home? Yes No ,?0, ,H ree,9 4 cc_
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 ForOft'leg,Use'.Only .t ., Amount Revisiom
Main Floor Heated EH Bid App Review:
1530 4(6961,in 7n.CO
2n1 Floor Heated Consistency Review:
Other Heated -0- Base fee: 1 `23 �J„G
■
Mezzanine Additional Section:
Heated Basement ' Plan Check fee:
APR 2 2 ".D - - 1'Jt.o1 -
Unheated Basement Slate Surcharge fee:
�' 4. 50
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL
Decks 911/Rd Approach fee:evtA
Other rc k. }( t a 25,6 (91A5% 6(i . TOTAL: $ a `61-1 lq
` Receipt Number: T-1 .35
�j Cash/Check Number:
ESTIMATED COST(REQUIRED) vv v "~( � Date: I ��'
•Fair market value of all labor and materials foundaborsto-linish 4 lc et
If. f Si o O ` Initials: C\�
G:\PermitCcnter\###FORIIVIS####\DRD FORMS\Master Permit Application 12-19-2006.doc
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