HomeMy WebLinkAboutBLD1995-00548 tIIj w
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JEFFERSON COUNTY BUILDING APPLICATION
Jefferson County Permit Center
Castle Hill Mall
621 Sheridan St.
Port Townsend, WA 98368
360-379-4450
PERMIT # •BLD95-0548 DATE RECEIVED. : 10/02/95
SITE ADDRESS: 7412 FLAGLER RD
:NORDLAND, WA 98358
APPLICANT. . . :CARL JOHNSON
MAILING ADDR:PO BOX 117 PHONE:
:NORDLAND WA 98358 / ?
CONTRACTOR. .
MAILING ADDR PHONE: 360-
•
CONTR. LIC #: EXPIRATION DATE:
ARCHITECT/ . . :
DESIGNER • PHONE:
MAILING ADDR:
PARCEL NO. . . : 021332032
LEGAL DESC. . : STR 33-30-01 EWM, TAX # ALT: DAN :
BY: DA LOT 1, BLOCK , TE:
WATER:,QMIT7 TE:ak
DESCRIPTION OF IMPROVEMENT: Addition and remo CAR ��� DATE:io � �,s
del
BUILDING TYPE •RES BEDROOMS--- BATHROOMS--
TYPE OF IMPROVEMENT:ADD EXIST. : 2 EXIST. : 2 MAIN FL. . . : 394 sf
GARAGE/CARPORT ADD L FL. . : 0 sf
PROP. . : 0 PROP. . : 0 HTED BSMT. : 0 sf
WOODSTOVE • TOTAL. : 2 TOTAL. : 2
UBC OCCUPANCY GROUP: SEWAGE DISP. . : SEPTIC THE BSMT. • 0 sf
O
TYPE OF CONST OTHER 0 sf
TYI 0 STORIES: 1 WATER SUPPLY. :PWELL CRPT/GAR. . : 246 sf
HEAT TYPES. :PRO/ / DECKS 0 sf
DIMENSIONS: MOBILE HOME .
FRAME TYPE:WOODCOMMERCIAL: 0 sf
EST COST. $: 51935 MAKE: YR: INDUSTRIAL: 0 sf
SIZE: BANK HT. . . : 0 ft
PROD GRP. . : 456
_ SH SETBACK: 0 ft
Owner/agent ,. —;,
Signature: FEES
AUG 2 3 t96 type amount by date recpt
Date: PRMT $ 587 . 25 EMH 10/02/95
95 111345
PLCK $ 176 . 17 EMH 10/02/95 111345
Issued By: Wourii 1 ., r B.C. $ 4 . 50 EMH 10/02/95 111345
2.Date:
$ 767 . 92 TOTAL
• �aL/D Lft)
JEFFERSON COUNTY PERMIT CENTER, 621 SHERIDAN ST, PORT TOWi1a5END WA 98368
BUILDING PERMIT APPLICATION
PROJECT DESCRIPTION: -6.6/77 G%A/ ,4,J
BUILDING TYPE: PROJECT TYPE:
►� SINGLE FAMILY FRAME TYPE:
❑
❑ GARAGE ATTACHED/DETACHED
❑ MODULAR � ADDITION ❑ STEEL
NEW WOOD
B.❑ COMMERCIAL ALTERATION/REMODEL ❑ CONCRETE
ElMULTI FAMILY/# OF UNITS ❑ REPAIR ❑ MASONRY
❑ DEMOLITION ❑ OTHER
❑ INDUSTRIAL
❑ OTHER
BEDROOMS: BATHROOMS: TYPE OF SEWAGE DISPOSAL:
EXISTING 7 EXISTING 2- ❑ SEWER ❑ COMMUNITY SYSTEM
PROPOSED PROPOSED -+' -
TOTAL ,� INDIVIDUAL SYSTEM CI Conventional
TOTAL _ PERMIT # SEP
❑ Alternative
WATER SUPPLY:
�( PRIVATE WELL TYPE OF HEAT:
CIPUBLIC Name of water system: El ELECTRICITY El OIL
❑ WOODSTOVE PROPANE
❑ HEAT PUMP ❑ OTHER:
SQUARE FOOTAGE�� ��
MAIN FLOOR q 43 !9 , Le.�
2ND FLOOR (� FOR OFFICE USE ONLY
3RD FLOOR
UBC OCCUPANCY GROUP
HTD BASEMENT
UNHTD BASEMENT
CARPORT BASE FEE ,..
GARAGE
DECKS PLAN CHECK 1 v. /
COMMERCIAL STATE SURCHARGE 4.50
INDUSTRIAL TOTAL �`
OTHER ,k.iM nq� ✓�� o�,1'.� (-9
TOTAL VALUATION
Or RECEIPT # vy
ESTIMATED COST \ CASK`/ CK # 0. ' ;
l
�` f / DATE1 i T. / d
IF WATERFRONT PROPERTY, fri
DISTANCE TO BANK OR HIGH WATER LINE
ft BANK HEIGHT ft
SIGNATURE
"""� DATE
NAME (PLEASE PRINT) CAR L. H J'0 s o w
H:\Home lPlncntr\Fwms10k1app,Frm 6/95
•
Jefferson County Permit Center Date
621 Sheridan Street Fee
Port Townsend WA 98368 Rec #
CRITICAL AREAS QUESTIONNAIRE Ck #
Case #
Applicant Name Gig 1Z L H .
Building Application Land Use Application Shoreline Application
On-site Sewage Application Subdivision Application Other: 4-po rim/ , 70,6
1 . Is there any standing or running water on the surface of the YES NO
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 X NO
identified as a wetland or swamp?
If YES, please describe:
3. Are any willows, skunk cabbage, alders, or cottonwoods present YES .X 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 '7<` NO
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)
Gi c Q 0 ❑
r / / / / / i
r r / / / / /
r r i / / / i
r i i / / / /
r I i / / / i
rr % / / / / /,
r r / / / / / �, ,,❑
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_-'❑
At
-
--------------
fl (Questionnaire Continues on Back)
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6. Does the site have steep slopes with little to no vegetation? YES KNO
If YES, please describe:
7. Does the site contain high percentages of silt and/or very fine YES 7' NO
sand?
If YES, please describe:
8. Does the site contain ground water seepage or springs near the YES '°CNO
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 C�, -;11 Date .2'7 5,212+ c1 J
FOR OFFICE USE ONLY
❑ Wetlands ❑ Seismic
CRITICAL AREAS ON OR ❑ Aquifer Recharge Area (zone ) ❑ Fish & Wildlife Area 1
IMMEDIATELYADJACENTTO SITE: ❑ Frequently Flooded Area ❑ Fish & Wildlife Area 2
❑ Erosion
❑ Landslide
Zone:
Parcel Size: Status:
Comprehensive Plan Land Use Designation: Reviewed by:
Community Plan: Date:
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