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Home My WebLink AboutBLD2015-00140 - 01 PERMIT APPLICATION IJILDING PERMIT APPLICATIaSV BLD15-00140 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD15-00140 Received Date: 4/23/2015 SITE ADDRESS: 42 KETCH LN PORT LUDLOW, 98365 OWNER: ROSALIND J TEVIS TRUSTEE PHONE: TEVIS TRUST AGREEMENT 350 N 190TH ST#C522 SEATTLE WA 98133-3868 9907 SUBDIVISION: Block: Lot: PARCEL NUMBER: 990700080 Section: 8 Township: 28 N Range: 1 E CONTRACTOR: RAY CANTERBURY PHONE: 360-301-0022 1761 LINGER LONGER RD QUILCENE WA 98368 REPRESENTATIVE: RAY CANTERBURY PHONE: 360-301-0022 1761 LINGER LONGER RD QUILCENE WA 98376 PROJECT DESCRIPTION REPAIR WATER DAMAGE ON THE WESTSIDE OF THE HOUSE. TO REPLACE DOOR ON UPPER FLOOR. ALL REPAIRS WILL MATCH EXISTING DESIGN. TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP ALT IN VALUATION 10,000.00 ADD'L: HEAT TYPE: CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $157.00 SRE 04/23/15 154350 Plan Check $102.05 SRE 04/23/15 154350 APPROVED State Building Code $4.50 SRE 04/23/15 154350 Total: $263.55 APR 2 9 2015 Jefferson County DCD 1\tidemark\data\forms\F_BLD_App_Bld.rpt 4/23/2015 • • A A. coG DEPARTMENT OF COMMUNITY DEVELOPMENT 44 `� 621 Sheridan Street,Port Townsend,WA 98368 u. ,a Tel:360.379.4450 I Fax:360.379.4451 " Web:www.co.iefferson.wa.us/communitydevelopment E-mail:dcd(2co.ieEferson.wa.us ' Lv �9I 1 71 PERMIT APPLICATION Li i t' Iv Steps in the Permit Process: -__J ication. -Review application checklist to ensure all information is completed prior to submitting application. . ' '' - °J'l rY c COMUNITY DEVELOPMENT -Make sure septic has been applied for and water availability has been proven. -Make an appointment to meet with the Permit Technician by calling 360-379-4450. -This is not a standalone application;it must be accompanied by a project specific supplemental application. -Fees will be collected at intake. Additional fees may apply after review and payment is required before permit is issued. For Department Use Only Building Permit# Related Application#s: MLA# Site Information Assessor Tax Parcel Number: 990700080 Site Address and/or Directions to Property:42 ketch In Port Ludlow Wa 98365 Access(name of street(s)) from which access will be gained: ketch In Present use of property: single family residence Description of Work(include proposed uses): Repair water damage on west side of the house. Replace door on upper floor. All repairs will match existing design. Wastewater-Sewage Disposal This property is served by Port Townsend of Port Ludlow sewer system? YES _✓ _ NO If not served by sewer identified above, identify type of septic system below: Type of Sewage System Serving Property: _ Septic Septic Permit#: ✓ Community Septic Name of System; Port ludlow sewer Case#: Are other residences connected to the septic system? Additions or repairs to sewage system: Is it a complete or partial system installation: Complete _ Partial _ — Has a reserve drainfield been designated? Yes _ _ No _ _ Date of Last Operations&Maintenance check: Attach last report to application Describe or attach any drainfield easements,covenants or notices on title,which may impact the property: o. D • • The authorized agent/representative is the primary contact for all project-related questions and correspondence. The County will mail/e-mail requests and information about the application to the authorized agent/representative and will copy (cc) the owner noted below. The authorized agent/representative is responsible for communicating the information to all parties involved with the application. It is the responsibility of the authorized agent/representative and owner to ensure their mailbox accepts County email(i.e. ,County email is not blocked or sent to"junk mail"). Applicant/Property Owner Information Property Owner: Name: Rosalind Tevis Address: 350 N 190th st Seattle Wa 98133 Phone#: 360-301-0222 E-mail Address: ✓_ Please contact Authorized Agent/Representative with project info. (select only one). Property Owner Signature: �^ �� l 11�/1 Date: (). Note: For projects with multiple owners,attach a separate sheet with each owner(s)information and signatures. Applicant: Authorized Agent/Representative(If other than owner) Name: Ray Canterbury Farwest home Address: 1761 Linger Longer rd Quilcene Wa Phone#: 360-301-0022 E-mail Address: raycanterbury@hotmail.com Professional: Is this an Authorized Agent/Representative for this project? NO YES ✓ Engineer Architect Surveyor Contractor ✓ Consultant Name: Ray Canterbury Farwest home Address: 1761 Linger Lonqer rd Quilcene Wa Phone#: 360-301-0022 E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: Address: Phone#: E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: Address: Phone#: E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: Address: n Phone#: E-mail Address: �, \v/ I �`1 Attach additional pages if necessary I !l Builders Statement 1 LI LS The signer of this statement certifies that they are the Owners of the parcel referenced herein,that they are npt-6c-►n sed contractors and that they will be assuming the responsibility of the General Contractor for the Ord�t�'segl_ ±[ #0mFNT Signature: Print Name: Date: • . oN DEPARTMENT OF COMMUNITY DEVELO r �5 C°6i 621 Sheridan Street,Port Townsend,WA 98368 LC f S I M L 7 Tel:360.3794450 I Fax:360379.4451 ti ■< Web:www.co.jefferson.wa.us/communitydevelopment U. E-mail:dcd @co.jefferson.wa.us 'TSN'rro °� ) SUPPLEMENTAL APPLICATION RESIDENTIAL OR COMMERCIAL BLDG PERMIT e COMMUNITY DEVELOPMENT For Department Use Only Receipt#: Date: Related Application#s: Payment it Site Information Owner Name: 12oSc,,I Grid Assessor Tax Parcel#: 99070oOgo Type of Building New Replacement Relocated Addition Repair X Demolition 'A separate permit is required Select One: Single Family Residence X Modular Other list Proposed Building/Project Number of floors 2 #new bedrooms existing total bed #new bathrooms existing 3 total bath Heat Source Select all that apply: Electric Heating Oil Wood Propane X Enter the square footage(sq/ft)that applies in each field: Structure Existing Sq/Ft Proposed Sq/Ft Residential/Commercial Main Floor /,372 Residential/Commercial Second Floor 6/Y Additional Floors-heated/unheated Basement-unfinished Basement-finished space or habitable _ Detached Garage-heated/unheated 7S-0 Attached Garage- heated/unheated Garage 2nd fl-unfinished storage Garage 2nd fl -finished space or habitable Carport-2 walls or less P Deck-uncovered 53 Covered porch Other(shed,barn, pole bldg,etc.) Estimated Cost of Project(Required): $ /o,000, v0 r ` • • List existing buildings on property(i.e. house,garage,accessory dwelling unit,shed, barn,mobile home,other): All Existing Buildings on Property Use _ Snr le_ -P ,n, 1/ IC.eS.d&rice cie ,cite a .7...(Yw3C f7 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 making any issued permit null and void. I further agree to that all activities I intend to undertake or complete associated with this permit will be performed in compliance with all applicable federal, state and county laws and regulations and I 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 - - inspections. Applicant may request notice of the County's intent to enter upon the property for visits ed to I is application and subsequent permit issuance} �/ Signatur, �� Print Name: �Gy l �� '/ Date: I/23�.5.— Estimated Cost of Project $ For Department Use Only Building Base Fees Building Base ‘6-7 "_c) Plan Check Review I c 2 , 05— Land Use Review Septic Review Potable Water Technology/Scan $ 95er 11'0) State Fee $4.50 Other Fees Shoreline Exemption Zoning Zoning Other New Address Road Approach Total Fees z'g 5 J s Receipt# 1S`1 k., Date: bl'25 q< Cash/Check/CC: CC Li cc 'g" 1 Parcel Details Page 1 of 2 • �.. Jefferson C Name County Info • Departments Search Parcel Number: 1990700080 j I SEARCH Parcel Number: 990700080 Printer Friendly Owner Mailing Address: ROSALIND J TEVIS TRUSTEE TEVIS TRUST AGREEMENT 350 N 190TH ST #C522 SEATTLE WA98133-3868 Site Address: 42 KETCH LN PORT LUDLOW 98365 Section: 8 School District: Chimacum (49) Qtr Section: SE1/4 Fire Dist: Port Ludlow (3) Township: 28N Tax Status: Taxable Range: 1E Tax Code: 0231 Planning area: Port Ludlow (7) Sewer: PLSEWER - Connected(No Drainage: PLDD YES CWF) Bank: View 1: Zoning 1: MPR-SF-4 - Master Planned Resort - Single View 2: Family Zoning 2: Zoning 3: Sub Division: 9907 - PORT LUDLOW NO. 3 Assessor's Land Use Code: 1100 - Residential - Single Unit Property Description: PORT LUDLOW NO. 3 LOT 80 Tax,A/V, Sales. Photos, and Permit Data Bldg Data Map Parcel Plats &Surveys Septic Monitoring Info _.... HOME I COUNTY INFO I DEPARTMENTS I SEARCH Jefferson County Best viewed with Microsoft Internet Explorer 6.0 or later Windows - Mac http://www.co.jefferson.wa.us/assessors/parcel/parceldetail.asp?value=990700080 4/23/2015