HomeMy WebLinkAboutBLD2018-00295 - 01 PERMIT APPLICATIOND,ro,NG PERMIT APP.,"o,(lh BLD18-00295
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #:
SITE ADDRESS
OWNER
SUBDIVISION:
PARCEL NUMBER:
BLD18-00295
125 CUB RD
PORT TOWNSEND, 98368
JERRY LEE RUBERT
TAMMI LYN RUBERT
PO BOX 449
PORT HADLOCK WA 98339.0449
001 321 094
ReceivedDate: 71912018
Lot:
PHONE:
Block:
Section: 32 Township: 30 N Range: 1V1
CONTRACTOR
REPRESENTATIVE:
TOWN & COUNTRY POST & FRAME
16521 HWY 99
SUITE C
LYNNWOOD WA98037-3161
Contractor's License TOWNCPF099LT
TOWN & COUNTRY POST FRAME
BRYAN BORCHERS
16521 HWY 99 STE C
PHONE: 425-743-1555
8t18t2018
PHONE: (425)743-1555
800-824-9552
Expires
PROJECT DESCRIPTION: NEW POLE BLD. NO HEAT NO PLUMBING
TYPE OF WORK
TYPE OF IMP
VALUATION
CODE EDITION:
OCCUPANCY:
OCCUPANCY:
CONST TYPE:
CONST TYPE:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS:
Exist:
Prop:
Total:
GAR
NEW
51,000.00
2015
BATHROOMS:
Exist:
Prop:
Total:
SQUARE FOOTAGE:
MAIN:
ADD'L:
HEAT BASE:
UNHEATED:
OTHER:GARAGE: 1,440
DECK:
Type
HEAT TYPE:
HEAT TYPE:
# OF STORIES
UH
SHORELINE:
SETBACK:
BANK HEIGHT:
Amount Paid Bv: Date: Receipt
Approved/Date
Permit
Plan Check
Consistency Review
Scanning Fee
State Building Code
Tech Fee
EH SEP/RES Rev
Total:
07t11t18
07t11t18
07111118
07t11t18
07t11t18
07 t11t18
07t11t18
178238
178238
178238
178238
178238
178238
178238
$586.00
$380.90
$276.00
$23.00
$6.50
$70.32
$134.00
SRE
SRE
SRE
SRE
SRE
SRE
SRE
$1,476.72
ilHfiiiriAH ILT
sion Of
DIRECTIONS TO SITE
16521 Highwa, nn,! C. Lynnwood, WA 98037-3161
Puyallup: (253) 840-9552
Administrative Headquarters : (425) 7 43-1 555
FAX: (425) 742-4378. 800-824-9552
Contractor's Lic. #: TOWNCPF099LT
permabilt.com . facebook.com/permabilt
Building Proud'"
V0EGr-tE
JOB NAME:
SHIP TO ADDRESS
Tcr-rq llTann,r^, kLrrt'm JUt s 2018
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TELEPHONE # AT JOB DROP a THOMAS GUIDE
Canasemi1turnaroundatthejobdrop?nYesE/ruoEBack-inonlynother
Can a two ton2 get into the job drop? V6t I No n Other./
Can a concrete truck get into the drop? W"" ! tto E Other
Will a 4 wheel drive vehicle be required for deliveries? E Yes E'(o E Other
Directions
POST FRAME BUILDINGS
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lTruck Dimensions: 65' long, 8' wide, 121/z'high, and it weighs 35,000 lbs. empty.
2Truck Dimensions: 30' long, B' wide, 121/z' high, and it weighs 18,000 lbs. empty.
illlilililIilllllO 2012 Perma-Bilt@ lndustries FR-35 10/17
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DEPARTMENT OF COMMUNITY DEVELOPME,NT
621 Shericlan Street, Port Torvnsend, \Ii;\ 98368
'I'cl: 360.379.4450 | Pax: 360.379.4451.
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PERMIT FEES WORKSHEET
Estimated Cost of Project 551,000.00 Parcel #
Permit #
001-321-094
Building Base Fees
Building Base
Plan Check Review
Land Use Review
Septic Review
Potable Water
Technology/Scan
State Fee
Other Fees
Shoreline Exemption
Zoning
New Address
Road Approach
Tech Fee
Total Fees
Office Use Only
Receipt Number:
Cash/Check/CC:
Date:
lnitials:
$t,qls.tz
ss86.oo
s380.90
s276.oo
s134.00
s23.oo
Se.so
570.32
I 20ts.flrt
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D
JEFFERSON COUNfi
DEPARTfUIHNT OF COMM
621 Sheridan Streetl Port Townsend, WA 98368 lWeb
Tel: 360.379,4450 | Fax: 360.379 4451 | Email:{,lwmrpxt@|tgov@gtr1n7*.^
fo; q Po$| €'rlr^4 De***Ua ffir4
3(d*cro' on $ "*:*.l.r*-lo"gp'x"ffin '? ?pL tr *fi{drt-,.,..,,*t ,f ry! ft&&rry-..4;drr4nr*r,*-" , ,
Property Size: l, 2b ***, ^__._._*{ggtqygg!lf 1gS0
Project Description (include separate sheets as necessary);
Tax ParcelNumber f3;61L1l Of-q
Site Address and/or Directions to Prope(y: I l,S CJ..!" LA'l Po"to toa:n (rR i$o*rtertd
t t
email:
Mailing Address:
Fax:
Faxr l+.
AppllcanUAgent (if dlffercnt from owner):
Property Owne(s) of Record;
Mailing Address:
0 Allowod "Yes" Use Consistenc) Analysis
D Stormwater Management
D Site Plan Approval Advance Determination (SPAAD) "
D Temporary Use
D Wireless Telecommunication t
E Forest Practices AcURelease of Six-Year Moratoriumr liayrequlrc e Prc-Apptica[ot Corferwtco
tr Lot or Road Segregation
tr Critical Areas Stewardship Plan
[] Variance (Minor, Major or Reaaonable Economic Use)
n Condllional Use [C(a), C(d), or Cl*
D Discretionary "D" or Unnamed Use Classification
tr Spocial Use (Essential Public Facilities) "
tr Boundary Line Adjustment
tr Short Plat "
D Binding Site Plan "
E Long Plat*'
Il Planned Rural Residential Development (PRRD)/Amendments s
tr Plat Vacation/Alteration *
O Shoreline Master Program ExemptionlPermit Revisions *
tr Shoreline Management Substantial Development *
tr Shoreline Management Variance
0 Comprehensive Plan/UDC/Land Use Districl Map Amendment
U Jefferson Counly Shoreline Masler Program Amendment
D Tree Vegetation Request
" Roquhes e Fr*Agpllca{lon Confergnce
l4&^r^g" Attached / Detached
D Modular
ItYhat klnd of Permlt? (Check each box tha{ appties
tl Road Aooroach
tr Cottage lndustry
fl6uilding
D Demolilion Permit'''Single FamilyI Manufaclured Horne[] Commercial 'il Change ofUse
fl Home Business
0 Propane
D Sign
il Address
Please identify any other local, state or federal permits required for thla proposal, if known:
acl in rnatters relating to this applic€tion for permit(s)
7, s. ts
I hereby designate
SIGMTL,RE
thal the information providod hsr6ln, and ln any attschmonts, i6 true ond oonect lo the best of
his, her or lts knowledge. Any materiel falsahood or any omiEsion of a matoriel facl made by th6 ownor/agent wlth rcspect to lhls appllcation packet
may result in lhis permit being null and vold.
I furlher agree to save, indernnlfy and hold harmless Jefferson County agoinsl all llabilitles, judgments, court costs, reasonable Bttomey'o feos and
oxp€nsos whlch may ln any way accr!,e against Jefferson Counly as a result of or ln consequence of tho granling of thls permlt.
I further agree to provlde acco6E and right of ontry to Jefferson County and lts employees, reprosentatMe8 or agents for the sole pumose of applicetlon
review and any required later lnspections. Staffs accesg and right of enlry will be assumed unless the appllcanl informs lhe County ln wdtlng at lhe
By signing this theform,owner/agenl
Dats.
time of the application that he or wents a -5.rO
oI the issuance ot this psrmlt mey negatively lmpact upon ono or rnor6 threatened or
endangered speciee and could lead to a potentlal "lake" of an endangered species as those lerms are defined in the foderal law known as the
'Endangered Specles Act' or "ESA." Jefierson County makes no assurances to the applicant lhat lha acllons thal will be underlakon becauso this
permlthasbeenissuBdwill nolviolatstheEsA. Anyindlvldual,grouporagencycanfilealawouitonbehalf ofanendang€redspeclesregardingyour
even if you are ln compliance with the Jeffsrson County development code. The Appllcant acknowledgos lhat he, she or it holds lndlvldualacllon(6)
wlthloforand
mta:
read this digclalmer and slgns and dates lt b€low.
Tho ac{ion or Applicant wlll undertake as
Building Permits & lnspocllons I Development Consisfency R eview I Long Rango Planning I iaiiiinid St"'raarn,p it;;;,i,, r;6Ettt;,;
Master Permit Application MLA:
l,cen
i7 /?4/aot)
tt)rstt L Tr} *"r..i lLr*oex'
Datg:
Signature:
7. f ./8SlgnaturB:
I
BUILDER STATEMENT
The signer of thh cletement does hareby certlfy lhat lhey ar6 lho Orvnors of the parcel referenced
they will be assumlng tha responslbility of the General Contractor for th€ proposBd project.
COUNTY
t&9()GENERAL
Slgnature Date:
/,u,kotfrJ0&,.herein, thal lh€y are not
PHONE:
({r5)
lVaLne AooResb:
CoNTRAcToR's LTCENSE
NUMBER:
ARCHTTECT/ENGINEER:
lvlerUNe AooREss:
Fex: (
Elanu
PHoNE ( )
Project Type:t' Newn Additiontl AlterationlRemodel
Ll Repair
tl Demolition
Typc of llorl:
-'**
Frame Type:f Wood
Ll Steel
I I ConcrEterl Masonry
i,l Other; "-"-""--...--."^
Bathrooms: U, R
Existing:
Total:
Bodrooms: f{
Existing:
Proposed:
Total:
tfr
Shorcline:
Setback;
Bank
Height:
Type of Sewage Disposal:
l'l Sewer
l.l Community System
,< Indiyidual System
SEP Permit # "_Water Supply:
tt Private well r j Two Party
lPublic
Name of Syslem,_
Ifllrirlsgjoumetpl.alfrgiqgtJoq,.r$.,a q&{
NumberofParkingSpaces:Cunent:-Proposed:NumberofADAPart(in9Spaces:-
Numberofoccupants(includesowners,tenants,employees,etc)Currenf-Praposed
lBcoccupancy:-lBCTypeofconstruction:-WillyouhaveFoodService?Yes/No
lf Jhlt l* a Propano Tank antltor AQ.rrllarrco lJ"r*qfpllal
Heat Stove Cook Stove Woodstove Fireplace.nsert
-.*.****rehtO
i evotStelleP i knaT retaWtoH 1
ls thls a.n{rllanca bolnqrinslaltld ln a Maflufacl$rod 1ilIa}ilo [olne? Yes / No
When applylng for a permlt to inshll a prcpane tank you musf also suD mit a slte plan showlng all of the bulldlngs, all property
llnes, lank locatlon and size, drsfances frcm the pto.pane tank to all prcpefty llnes, bulldlngs and septlc systern component$,
lncludtng the reserue arca.
Size of Propane Tank:Underground Tank Above ground tank
For Offlce Uee Onlv AmountCurrcnt Revlslon
EH Bld App Review:Main Floor Heated lBno
2'" Floor Heated Consistency Review;
Other Heatad Base fee:
Mezzanine Additional Seclion:
Heated Basement Plan Check fee:
Unheated Basement Slate Surcharge fee:
Other Unheated PotWater Review fee:
Garage/Carporl
XJlo.p
SUBTOTAL
Decks 91l/Rd Approach fee:
9-lt.p TOIAL:$
I u
ESTIMATED COST (REOUIRED)
;Fair makat value ol all labor and matedals lauadation to linish
S 3).cr>o
Receipt Number:
Cash/Check Number:
Date:
lnltlals:
$7 /24/2UrX
Nuufit:tt
0KAlt *rr*.-" a.rr*zl.,,o.
Related lication #s
For Department
o o
DEPARTMENT OF COMMLINITY DEVE,LOP
6f I Shcricl:rn Strcct. l\rrt'l',trvnscrrtl. W,\ 98363
'ltl: 360.379.4"15(l i lr:rx: 360.379.1411
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SUPPLEMENTAL APPLICATION
RESIDENTIAL OR COMMERCIAL BLDG PERMIT
Enter the square footage (sqft) that applies in each field
Site lnformation
Assessor Tax Parcel #: OOI ba , OqqOwner Name
Relocated _
Demolition _ _ *
*A separate permit is required
Type of Building
Modular other x PHr.c,,*
Replacement
Repair
New X
Addition
Proposed Build ing/Project
# new bedrooms
# new bathrooms
existing
existing
total bed
total bath
Number of floors
Heat Source tJ/A
Select all that apply
Electric Wood PropaneHeating Oil tr
Structure Proposed Sq/Ft ICC Valuation (office Use)
Residential / Commercial Main Floor I 8A)
Residential / Commercial Second Floor
Additional Floors - heated / unheated
Basement - unfinished
Basement - finished space or habitable
Detached Garage - heated / unheated B?b
Attached Garage - heated / unheated
Garage 2nd fl - unfinished storage
Garage 2nd fl - finished space or habitable
Carport - 2 walls or less
Deck - uncovered
Covered porch
other (shed, barn,@-le bl@etc.)lqqc)
$
Receipt #:Date:
#:
E-b V
,0rg
Select One:
Single Family Residence
fl
Existing Sq/Ft
lr tKequrreo
oI
List existi build on .e. hou dwellin un shed ba ile home othe
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 or her 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 making any issued permit null and void.
Sign ature: )-,0; trUjr.,r^+rr. Print Name Date: 7.Z.tV>1:-F--
All Existing Buildings on Property Use
l8tx) ss TZ-o-siA.o/1c4-
97co se 'artra.-Ae ( },?rrya-q-edct
The signer of this statement certifies 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 the General Contractor for the proposed project.
Signature rint Name Date
Building Permit Fees
Building Base
Plan Check Review
Land Use Review
Septic Review
Potable Water
Technology/Scan
State Fee
Other Fees
Shoreline Exemption
New Address
Total Fees
s270.oo
S131.oo
5176.00
S23.oo
S4.so
Receipt #Date:Cash/Check/CC:
Builders Statement
Zoning
Zoning
Other