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HomeMy WebLinkAboutBLD2015-00097 - 01 PERMIT APPLICATION °BUILDING PERMIT APPLICAON BRLD1e00097 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD15-00097 Received Date: 3/27/2015 SITE ADDRESS: 657 RAINIER LN PORT LUDLOW, 98365 OWNER: WILLIAM KLEIN PHONE: 657 RAINIER LN PORT LUDLOW WA 98365-9775 9901 SUBDIVISION: Block: Lot: PARCEL NUMBER: 990100018 Section: 17 Township: 28 N Range: 1E CONTRACTOR: WAYNE LOUNABURY PHONE: 360-821-2919 36 MCKENZIE LN PORT LUDLOW WA 98365 Contractor's License GENERPM866JA Expires 4/1/2016 REPRESENTATIVE: WAYNE LOUNSBURY PHONE: 360-821-2919 P.O. BOX 65191 PORT LUDLOW WA 98365 PROJECT DESCRIPTIOP NEW PARTICAL ROOF OVER EXISTING DECK TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 13,872.00 ADD'L: HEAT TYPE: CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: CONST TYPE: OTHER: 480 SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: SEW WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $201.00 SRE 03/26/15 154248 Plan Check $130.65 SRE 03/26/15 154248 APPROVED State Building Code $4.50 SRE 03/26/15 154248 G Total: $336.15 APR 0 7 2015 Jefferson County DCD \\tidemark\data\forms\F_BLD_App_Bld.rpt 3/27/2015 •Up Front Parcel Reviews et5d -7-- Parcel 990100018 Printed: March 27, 2015 WILLIAM KLEIN SiteAddress(es). 657 RAINIER LN 657 RAINIER LN PORT LUDLOW, WA 98365 PORT LUDLOW, WA 98365-9775 Parcel Number: 990100018 S-T-R: 17-28N-1E Total Acreage 1 Legal Description PORT LUDLOW NO 7 LOT 18 SUBJ TO ESMTS OF Land Use: 1100 RECORD Flood District: Fire District: 3 Planning Area: 7 Flood Map(FIRM)Panel No: School District 49 Zoning: eci?.._—.5(--- COMP PLAN DESIGNATION: COyMUNITY PLAN: UGA: UGA Trans [ VI Plot plan states "property line" [ ✓` Assessor's Map (Property lines ubmitted plot plan must match the property lines as identified on the Assessor's 1/4 map) [✓�J, Legal Access to Property NO [ tX Parcel Tags or Scanned Documents YES [ t ' ESA's: Special Reports Nearby YES NO [ Designated Ag YES [ ] Shoreline Designation: YES . [ii]' Shoreline Slope Stabili 400 NO .3,+i Stream Type:YES NO FWHCA: YES NO Wetlands: YES NO Rare Plants:YES NO _ Seismic: YES NO _ . Landslid- NO : . �r'1'L: • -`•w, • L . e • • ...` .■ Flood: • S NO �os _ .. • -_ _ i.1 Erosion: YES NO Aquifer Recharge Area:YES NO SIPZ: none At Risk High Risk .._ ..C. Coas CMZ: none High Risk Moderate RiskDisconnected CMZ Stormwater site plan submitted: YesNo [0--- Forest Lands: YES NO Adjoining Forest Lands: Commercial/ Rural/ Inholding [ L Mineral Lands: YES ENO [ V Agricultural Lands: YES o [ L'f Archaeology: YES In U/No Shooting Zone: 401111 NO [ VI Stormwater: New Im.-+ '. • urface ") '6 0 Land Disturbing Activity ESA's Stormwater Req's- 1',W-• • Min Req#1 thru#5 Min Req#1 thru#10 Engineering [ V1 Notice Provisions III is osure:Airport YES NO MRL YES NO Forest Lands YES NO [ . Landscaping Required: Yes No [t/] Parking Spaces Requ're• NO 2 Other [ vr Building Height: iliP :C Standard [ 14 Impervious Surface cover percentage: Resource Lands&Public: I oar Rural ResidentialC& Rural Ind�l: Per UDC Sec 6.7 Rural Commercial: 60% Area of Building Coverage:60%in Rural Industrial Lands only [ Total Building(s) Size: RVC:20,000 SF CC:5,000 SF NC: 7,500 SF GC: 1 SF All others:subject to se tic&water constraints/None specified [I/] Setbacks: Front: 2 J Left Side: Right Side: Rear: Shoreline Setback: LSHA Setback: [ (j]' Road Classification: Road Approach: EXISTING NOT REQ'D RAP [ V SEPA Required: YES EXEMPT [ 4 Flood Certificate: [ (, Existing Case(s) &Condition(s): Violations: Yes No [t/r Recorded Date of Subdivision: AFN Over 5yrs=UDC Plat Conditions: <5yrs=Plat Conditions on plat or Old Ordinance [ Lots/Require Declaration of Restrictive Covenant�l'�S O, submitted: YES NO [ UGA No Protest Agreement YES OW submitted: YES NO [(/T Site Visit conducted YES 0 [( Require Final Zoning Approval YES CP [ i/j"- ADMIN: Setbacks entered in Permit Plan case qtro YES New Parcel Tags entered in ' -rmit Plan (e) YES Special Reports Scanned 13111 YES No parcel tags found for parcel Cases Associated with APN 990100018 Review Cases Name Type Status Planner BLD15-00097 KLEIN I P David Wayne Johnson Application Received: 3/27/2015 Permit Issued/Case closed: Case Finaled: NEW PARTICAL ROOF OVEN EXISTING DECK BLD98-00122 DARCY F Application Received: 2/26/1998 Permit Issued/Case closed: 4/20/1998 Case Finaled: 3/3/1999 single family residence w/attached garage CAR98-00051 DARCY F Application Received: 3/2/1998 Permit Issued/Case closed: 4/20/1998 Case Finaled: 4/20/1998 single family residence w/attached garage \\tidemark\data\forms\R_Parcel_CRMLA.rpt 3/27/2015 Page 2 of 2 •Up Front Parcel Reviews e)1.57--) Parcel 990100018 Printed: March 27, 2015 WILLIAM KLEIN Site Address(es): 657 RAINIER LN 657 RAINIER LN PORT LUDLOW, WA 98365 PORT LUDLOW, WA 98365-9775 Parcel Number: 990100018 S-T-R: 17-28N-1E Total Acreage 1 Legal Description PORT LUDLOW NO 7 LOT 18 SUBJ TO ESMTS OF Land Use: 1100 RECORD Flood District: Fire District: 3 Planning Area: 7 Flood Map(FIRM)Panel No: School District 49 Zoning: 1 4?V----5{7 COMP PLAN DESIGNATION: COyMUNITY PLAN: UGA: UGA Trans [ VI Plot plan states "property line" [ Assessor's Map (Property lines ubmitted plot plan must match the property lines as identified on the Assessor's 1/4 map) [ Legal Access to Property NO y [ tX 'Parcel Tags or Scanned Documents YES [ Ci}""ESA's: Special Reports Nearby YES �NO [ Designated Ag YES [ ] Shoreline Designation: YES _.• [1 - Shoreline Slope Stabili 3:14P' NO c.A.,.i- ,4 (,p Stream Type:YES NO FWHCA: YES NO Wetlands: YES NO Rare Plants:YES NO Seismic: YES NO Landslid NO . --- a ,.A,►`,.a. . • IL . e. • r Flood: • S NO (i�.tn top A a,,,....ac-- Erosion: YES NO 0 Aquifer Recharge Area:YES NO SIPZ: none At Risk High Risk (Coasr� CMZ: none High Risk Moderate RiskDisconnected CMZ Stormwater site plan submitted: YesNo [ I4 Forest Lands: YES NO Adjoining Forest Lands: Commercial/ Rural/ Inholding [ tor Mineral Lands: YES NO [ (,}' Agricultural Lands: YES 0 [ yr Archaeology: YES to v/No Shooting Zone: 4rap NO [ V' Stormwater: New Im.- '.- urface 5-S b 0 Land Disturbing Activity ESA's Stormwater Req's' . il' t Min Req#1 thru#5 Min Req#1 thru#10 Engineering [ i/f Notice Provisions I Ise osure:Airport YES NO MRL YES NO Forest Lands vEs NO [ Landscaping Required: Yes No [ ] Parking Spaces Requ're, NO 2 Other 1 Building Height: 0 :C Standard [ (4 Impervious Surface cover percentage: Resource Lands&Public: 10 Rural Residentia. ° Rural Ind�I: Per UDC Sec 6.7 �/ Rural Commercial: 60% Area of Building Coverage:60%in Rural Industrial Lands only [ `7 Total Building(s) Size: RVC:20,000 SF CC:5,000 SF NC:7,500 SF GC: I SF All others:subject to se tic&water constraints/None specified [11 Setbacks: Front: 7 O Left Side: Right Side: Rear: Shoreline Setback: LSHA Setback: [ (j]' Road Classification: Road Approach: EXISTING NOT REQ'D RAP [ SEPA Required: YES EXEMPT [ r/]' Flood Certificate: [ V Existing Case(s) &Condition(s): Violations: Yes No [v1 Recorded Date of Subdivision: AFN Over 5yrs=UDC Plat Conditions: <5yrs=Plat Conditions on plat or Old Ordinance LA [ ' Lots/Require Declaration of Restrictive Covenant 0: --i110, submitted: YES NO [ V UGA No Protest Agreement YES 41V11 lisubmitted: YES NO [14 4 Site Visit conducted YES 40 [y( Require Final Zoning Approval YES am [ 1.4"- ADMIN: Setbacks entered in Permit Plan case 4270 YES New Parcel Tags entered in ' rmit Plan al YES Special Reports Scanned IP YES No parcel tags found for parcel Cases Associated with APN 990100018 Review Cases Name Type Status Planner BLD15-00097 KLEIN I P David Wayne Johnson Application Received: 3/27/2015 Permit Issued/Case closed: Case Finaled: NEW PARTICAL ROOT- OVEK EXISTING DECK BLD98-00122 DARCY F Application Received: 2/26/1998 Permit Issued/Case closed: 4/20/1998 Case Finaled: 3/3/1999 single family residence w/attached garage CAR98-00051 DARCY F Application Received: 3/2/1998 Permit Issued/Case closed: 4/20/1998 Case Finaled: 4/20/1998 single family residence w/attached garage 1ltidemarkldatalforms\R_Parcel CRMLA.rpt 3/27/2015 Page 2 oft • �,LS0N c,06 DEPARTMENT OF COMMUNITY DEVELOPME 621 Sheridan Street,Port Townsend,WA 98368 W K# Tel 360.379.4450 Fax:360.379.4451 �• 'i r �9m-" '� �� Web wwwco.}efterson.wa.us/couununitydecelopment E-mail:dcd@co.jefferson.wa.us �(� ILC Cl �s�1�G�o PERMIT APPLICATION D MpR 26 2415 Steps in the Permit Process: E�RSpND�D `TO -Review application checklist to ensure all information is completed prior to submitting .ppitcativsl c °NRv• -Make sure septic has been applied for and water availability has been proven. oF. -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 C� q Assessor Tax Parcel Number: I ( ter 6007 ( CJ Site Address and/or Directions to Property: ,5j 'I KC-on tF�e• kv), ,;V t- - Q l CO i Access (name of street(s)) from which access will be gained: r cL,1„,N ed--• Present use of property: R i„utlQ. �v �l, ,o Q,L e v.Le Description of Work(include proposed uses): f r■4-tC. ( r„,,.,f 119 LI eAr.. -V S-1,,;t,0, c�,1,f 2 r-e_CA,^ 0-P �e J Wastewater-Sewage Disposal This property is served by Port Townsend of Port Ludlow sewer system? YES N. _ 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: 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: • The authorized agent/representativ the primary contact for all project-related quellis 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: B i t( J ( Q, VN Address: i5 ', lv.\',e ' k v-■. Poi-1- h rrQ (z +- ` Wit . cif)5c- _ Phone#: _ E-mail Address: _ _ Please tact Auhhoriized Agent/Representative with project info. (select only one). Property Owner Signature: , ,ti \ '-X '-m l._-f , Date: 3/a(i/ c Now For projects with multiple owners,attach a separate sheet with each owner(s)information and signatures. Applicant: Authorized Agent/Representative(if other than owner) (A1 Name: �rNZ; kwor. S bJ^ Address: 2,c ple-Lm7'i;,_ kp.,NI- kt,k602, wA Phone#: '',;( p•- Q,Q_N•— 3,9 lc( E-mail Address: apmuS4 .;? (r(iYIC( ij ,..rerii Professional: Is this an Authorized Agent/Representative for this project? NO J Engineer Architect Surveyor x Contractor Consultant Name: (.IleanQ (cJr./1C 1' Address: ti(<, ilY (1 1!`T i'w & lui !- Phone#: `�1, 0 -V \r-)..._C kci E-mail Address: 6.,pfIUC1O 1y(1 tt/ i nn Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: Address: II 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: Phone#: E-mail Address: Attach additional pages if necessary Builders Statement 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: Print Name: Date: . • • ���5oN ce) DEIPARTMENT OF COMMUNITY DEVELOPME M WA 98368 S��" �� W Tel:360 3 i9 4450 f Fax:360.379.4451 �- i ^� .l, Web:www co iefferson w a.us!cormuunitydevelopment �i E-mail:dcdnco.iet erson.wa.us 2 6 VS •+ -.S'HI N Gvo SUPPLEMENTAL APPLICATION RESIDENTIAL OR COMMERCIAL BLDG PE I F1 oFCOMM°N''ov0pMENj For Department Use Only Receipt#: Date: Related Application#s: Payment#: Site Information Owner Name: (6;it K ( e't n Assessor Tax Parcel#: Griot Om(e Type of Building New )4 Replacement Relocated Addition Repair Demolition * 'A separate permit is required Select One: Single Family Residence Modular Other qc,„-p list Proposed Building/Project Number of floors \ #new bedrooms C2 existing a total bed CJ #new bathrooms V existing 0 total bath v I Heat Source Select all that apply: Electric 0 Heating Oil U Wood Q Propane (j Enter the square footage(sq/ft)that applies in each field: Structure Existing Sq/Ft Proposed Sq/Ft esidential Commercial Main Floor ati I g Resi.ential/Commercial Second Floor O Additional Floors-heated/unheated U Basement-unfinished 0217 Basement-finished space or habitable 0 Detached Garage-heated/unheated C7 Attached Garage-heate n eated 11 OAS Garage 2nd fl-unfinished storage C) Garage 2nd fl-finished space or habitable CD Carport-2 walls or less CD Deck-uncovered /f Q Covered porch 3 L{ Li eo>( 11.43q Other(shed,barn, pole bldg,etc.) 0 Estimated Cost of Project(Required): $ 915 d3 ao • • List existing buildings on property(i.e.house,garage,accessory dwelling unit,shed, barn,mobile home,other): All Existing Buildings on Property Use 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 later inspections. Applicant may request notice of the County's intent to enter upon the property for visits related to •is application and subsequent permit issuance. Signature: /[�tuL� . ..... Print Name:' C 1AP LumSkt `` Date: 3/t/ic Estimated Cost of Project $ � [ ©CO`° For Department Use Only Building Base Fees Building Base Q()t .0 Plan Check Review 60 sko� Land Use Review $*2=0 .t) Septic Review Potable Water Technology/Scan State Fee $4.50 Other Fees Shoreline Exemption • Zoning J Zoning Other New Address Road Approach Total Fees 9P1 Receipt# Date: Cash/Check/CC: 1 246 Nd-(1/ H 5 1 • n��(J BLD15-00097 BUILDING PERMIT APPLICATION Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD15-00097 Received Date: 3/27/2015 SITE ADDRESS: 657 RAINIER LN PORT LUDLOW, 98365 OWNER: WILLIAM KLEIN PHONE: 657 RAINIER LN PORT LUDLOW WA 98365-9775 9901 SUBDIVISION: Block: Lot: PARCEL NUMBER: 990100018 Section: 17 Township: 28 N Range: 1E CONTRACTOR: WAYNE LOUNABURY PHONE: 360-821-2919 36 MCKENZIE LN PORT LUDLOW WA 98365 Contractor's License GENERPM866JA Expires 4/1/2016 REPRESENTATIVE: WAYNE LOUNSBURY PHONE: 360-821-2919 P.O. BOX 65191 PORT LUDLOW WA 98365 PROJECT DESCRIPTION NEW PARTICAL ROOF OVER EXISTING DECK TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 13,872.00 ADD'L: HEAT TYPE: CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: CONST TYPE: OTHER: 480 SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: SEW WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid Bv: Date: Receipt: Approved/Date Permit $201.00 SRE 03/26/15 154248 Plan Check $130.65 SRE 03/26/15 154248 State Building Code $4.50 SRE 03/26/15 154248 Total: $336.15 1\tidemark\data\forms\F_BLD_App_Bld.rpt 3/27/2015 0 0 �4��gON cbG� DEPARTMENT OF COMMUNITY DEVELOPMEI T 611 Sh rid:a titre t.P,■a 1 ti usend VC'.V ')33{,`' `� �' Tel inn ,-9 4350 Fix: Sot■T-9 445 1 tC'eb v.�<c c;iekz is m-n a u. c onuu uniirdck F:10031:(-i,! \U\ L:-m,il a,d'il cu tc,th-rsun«i it rjt `-- . `', , �9S1/rNG °� ,e, =:::-- 1015 PERMIT APPLICATION \\ `', \e 2 Steps in the Permit Process: \1, 'J\---- ��`ttic. ' 0E. -Review application checklist to ensure all information is completed prior to submitting apoi)cat �{C,c -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: CI y Oj 000 i b Site Address and/or Directions to Property: S 1 k c A . tQ:r- I.vN, jey,T .LxQ. OW Access(name of street(s)) from which access will be gained: le''cltiv\\ ;r Present use of property: C i.v-).0�l� �`C1in'�i� y" A.QIC�"L°2 Description of Work(include proposed uses): .0cter 4-y-i ( rcxle 0)02Ar. -EA/i L.v0. ,14co (_` 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: 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: 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: 1j 11 1°� I ■ y1 I pp ++ � I p� Address: �5 � r(A ..r\\eV" ham_ l�'!)j4 LA IO (A A �E"1,G-,c Phone#: E-mail Address: Please pact A horized Agent/Representative with project info. (select only one). X Property Owner Signature: �4 ..-t- ,�-�_ Date: 372(30 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: Ll h( t\� LJ� VIJ,A Address: ? E (un7'tw_ &PN-1- A t kk Lni,t; i%r7 Phone it: ?-,cr) - g,.\— 9 (c( E-mail Address: a.pMU,c4 c?( Q i( t,CAwv) Professional: Is this an Authorized Agent/Representative for this project? NO Engineer Architect tr Surveyor X Contractor Consultant Name: (..l,1Cpijrte f�!JiAnSIQ )) � ` ++ � '' n Address: ti C� L'i' �'t r,.v.2LP. Lll`' r� l ) K IJ A Phone#: .r'S�C�- 7j�\r-'�Ci kel E-mail Address: 6..1 y3iUc',¢-(C.-) 0vtv..t1 , Cc , \\ 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: Phone#: E-mail Address: Attach additional pages if necessary Builders Statement 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: Print Name: Date: • ,_ r a . �goly t�I I _SfI [ 41a�'`� i (�] CC)�1'ltu�'v� i� IMF;` i ;I_.°i A1i .N ��SHING��� SUPPLEMENTAL APPLICATION RESIDENTIAL OR COMMERCIAL BLDG PERM — - For Department Use Only Receipt tt: Date: Related Application#s: Payment#: Site Information Owner Name: .).j I I K I e=t n Assessor Tax Parcel#: 99c coo 1� Type of Building New Replacement Relocated Addition Repair Demolition *A separate permit is required Select One: Single Family Residence Modular Other Rot)-- list Proposed Building/Project Number of floors k #new bedrooms 0 existing a total bed C1 #new bathrooms () existing t? total bath O Heat Source Select all that apply: Electric 0 Heating Oil O Wood (5 Propane (� Enter the square footage(sq/ft)that applies in each field: Structure Existing Sq/Ft Proposed Sq/Ft esidential Commercial Main Floor a � j t Resi ential/Commercial Second Floor Additional Floors-heated/unheated C.) Basement-unfinished P. k.'1 Basement-finished space or habitable Detached Garage-heated/unheated Attached Garage-heate n Bated 17 aS Garage 2nd fl-unfinished storage Garage 2nd fl-finished space or habitable Carport-2 walls or less Deck-uncovered / &If Covered porch 3 Li SO X iq•3 Other(shed, barn, pole bldg,etc.) Q Estimated Cost of Project(Required): $ 9)5 .ad pp) �JV�Z List existing buildings on property(i.ouse,garage,accessory dwelling unit,shed�n, mobile home,other): All Existing Buildings on Property Use 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 later inspections. Applicant may request notice of the County's intent to enter upon the property for visits related to%is application and subsequent permit issuance. Signature: ii$iAuk, ._. Print Name: ( A•j•",z !^ILI h jn 1 Date: 3/t /LS Estimated Cost of Project $ ids( v For Department Use Only Building Base Fees Building Base @OI Ci O Plan Check Review 60 AO'S— Land Use Review (S) Septic Review Potable Water Technology/Scan PI.3-0 State Fee $4.50 Other Fees Shoreline Exemption Zoning Zoning Other • New Address Road Approach Total Fees Receipt# Date: Cash/Check/CC: 1 1246 �jf�1,/1S I C-C1 • BLD15-00097 BUILDING PERMIT APPLICATION Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD15-00097 Received Date: 3/27/2015 SITE ADDRESS: 657 RAINIER LN PORT LUDLOW, 98365 OWNER: WILLIAM KLEIN PHONE: 657 RAINIER LN PORT LUDLOW WA 98365-9775 9901 SUBDIVISION: Block: Lot: PARCEL NUMBER: 990100018 Section: 17 Township: 28 N Range: 1E CONTRACTOR: WAYNE LOUNABURY PHONE: 360-821-2919 36 MCKENZIE LN PORT LUDLOW WA 98365 Contractor's License GENERPM866JA Expires 4/1/2016 REPRESENTATIVE: WAYNE LOUNSBURY PHONE: 360-821-2919 P.O. BOX 65191 PORT LUDLOW WA 98365 PROJECT DESCRIPTIOI NEW PARTICAL ROOF OVER EXISTING DECK TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 13,872.00 ADD'L: HEAT TYPE: CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: CONST TYPE: OTHER: 480 SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: SEW WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $201.00 SRE 03/26/15 154248 Plan Check $130.65 SRE 03/26/15 154248 State Building Code $4.50 SRE 03/26/15 154248 Total: $336.15 11tidemark1data\forms\F_BLD_App_Bld.rpt 3/27/2015