HomeMy WebLinkAboutBLD2015-00065 - 01 PERMIT APPLICATION BUILDING PERMIT APPLICOION BLD15-00065
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD15-00065 Received Date: 3/6/2015
SITE ADDRESS: 970 BEE MILL RD
BRINNON, 98320
OWNER: SEATTLE COUNCIL PHONE: 360-796-4427
OF BOY SCOUTS OF AMERICA
PO BOX 440408
SEATTLE WA 98114-4408
SUBDIVISION: Block: Lot: 1+
PARCEL NUMBER: 602131002 Section: 13 Township: 26 N Range: 2V1
CONTRACTOR: SANDERSON THE SAFETY COMAPNY PHONE: 253-709-7119
1101 SE THIRD AVE
PORTLAND OR 97214
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP INSTALL PER-ENGINEERED ANSUL FIRE SUPPRESSION SYSTEM TO
A PRE-PIPED COMMERCIAL KITCHEN HOOD
TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL:
TYPE OF IMP NEW MAIN: INDUSTRIAL:
VALUATION 1,580.00 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: NUMBER OF EMPLOYEES:
WATER SYSTEM:
BATHROOMS:
Exist:
Prop:
Total:
Routing Date:
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $57.00 SRE 03/06/15 154141 APPROVED
State Building Code $4.50 SRE 03/06/15 154141 V
Plan Check $36.50 SRE 03/06/15 154141 APR 2 4 2015
Permit $0.05 SRE 03/06/15 154141
Total: $98.05 Jefferson County DCL
1\tidemark\data\forms\F_BLD_App_Bld.rpt 3/23/2015
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�SOiv co DEPARTMENT OF COMMUNITY DEVELOPMENT
ct a 621 Sheridan Street,Port Townsend,WA 9b368
�� Tel 360.3'9 4450 1 as 360.379.4151
Wcb www.wgCferson.wa.us/eommunitvdcvclopmcnt
Email dcd @c,>isttereon.waus T4j-D1S�I sw 1 N CS,O� �/�`�'
PERMIT APPLICATION
Steps in the Permit Process:
-Review application checklist to ensure all information is completed prior to submitting application.
-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: Lo C) t 7 (C) C.% Z.
Site Address and/or Directions to Property: q' 10 8 ef2.- PA It Rc•
`3rini)P0 i WC.. G$6320
Access (name of street(s)) from which access will be gained:
Present use of property: (_,G+ M(� ` J /n�
Description of Work(include proposed uses): 1r s4&\ re--en i r _''€CC` HyistA �\�f`DL
s presst'o� sys+eew, 1-0 r, pc1P_- el pea. C_o✓vtrviPrbi4t
K-.1.\---c-hen �,acid.
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:
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isON Co DEPARTMENT OF COMMUNITY DEVELOPMENT
4t,' oe,.,, 621 Sheridan Street,Port Townsend,WA 98368
W Tel:360.379.4450 I Fax:360.3794151
,-< Web:www.co.iefferson.waus/communuydevelopment
E-mail:dcd@cosiefferson.wa.us
I'SjII1vG`�O SUPPLEMENTAL APPLICATION
RESIDENTIAL OR COMMERCIAL BLDG PERMIT
For Department Use Only Receipt#: Date:
Related Application#s: Payment#:
Site Information
Owner Name: L,rn p PCB' .- - Assessor Tax Parcel#: (d,4 - 3 :
- <J;,
(' . i'lArrt'4' t CGi( I(,O C f.n
Type of Building
New X Replacement Relocated
Addition Repair Demolition *
"A separate permit is required
Select One: i 7:iS
Single Family Residence Modular Other list
Proposed Building/Project
Number of floors #new bedrooms existing total bed
t.--4/A # new bathrooms existing total bath
Heat Source
Select all that apply:
�iElectric Heating Oil Wood Propane
pc
Enter the square footage(sq/ft)that applies in each field:
Structure Existing Sq/Ft Proposed Sq/Ft
Residential/Commercial Main Floor
Residential/Commercial Second Floor
Additional Floors-heated/unheated
Basement-unfinished
Basement-finished space or habitable
Detached Garage-heated/unheated
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, pole bldg,etc.)
Estimated Cost of Project (Required): $ 1 56)- G<;
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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 this application and subsequent permit issuance.
Signature: Print Name: Date:
Estimated Cost of Project $
For Department Use Only
Building Base Fees
Building Base
Plan Check Review
Land Use Review $228.00
Septic Review $79.00
Potable Water $107.00
Technology/Scan $19.00
State Fee $4.50
Other Fees
Shoreline Exemption
Zoning
Zoning
Other
New Address
Road Approach
Total Fees
Receipt# Date: Cash/Check/CC:
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The rinthutiLed agnnaireproeutatire is the pima ty comsat cot all project-related questions anal euttespoudeuce. ?Inc County
elneil requests and Mien:Rion about 1119 amlirslion to the authedeed.agentitcpipentadve sod%sill color(cc)the mister,
nowt below. The authorized agent(tepasenretrire to tespcnisiale for corruituirentutg the in formation to llpts invoked with
the n Alcation. tit tesponsitigny of the nuthorixed agety/sepacsentatire and Mall to ensure their mailbox accepts Cousin'
• cmai s. .-mum cum tIllot anckeri or snit so-link mail"
A ,licaut/Pretsarty_damst information
Property Owner: 'cp.' k Art 1-,E Cen4Alci
f Name cia ()EFT" •F cc/C Pi\-e9,4,6 • •
Address: rzt P...0 pa-r
Phone d: - • - &mail Address:
. Please conta IV?ell •:en I'•,.resentative with project Info.Mart only one).
Pro tarty Owner SE netrete: _„„oe,,,liffrfaa4d1416//fidr Date: ert.404 fs J
„Ita- suittneul qtted,.. pittate shrnttnItheaelmutte I hunt oengnalurty,
'••ticeittt Authinked•..ent •inteS• a lye itedietuusetared • .-- , •
Name: - 44t.- — •
Address: 4.0 r A
MirMAIMILeate
Phon e it: 6„• irartk Elliott Address: !, • ••Lir
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Proteeeittnah ".fifteen AtithEntelfAgentAteitresentatniefOr thiS ••. '
Engineer Architect Surveyor Contractor Consultant
I Name
Address:
Phoned: E.mail Address: •
• •
Proteasititints , : .1s this an Authoilied Ageht/RepresentativeoPthlf pfojeet? ' NO. YES-
Engineer Architect Surveyor Contractor Consultant-Name;
Address)
Phone N: E-mail Address:
PrIilenitl ,14fitiah.Atitheirked k-getilantejihisetitighttt fat No YES'.
Engineer Architect Surveyor Contractor ' Consultant
—
• •
Address:
—
Phone Emall AddreSst
LPPaceSlitnelt- , . •.61.hie.aifAtlflioriatecfAgent/Represefdailvfflfcif*PrOlett,:' ". ' 'NO' • YES_
Engineer Architect Surveyor Contractor - Consultant
Name:
Address:
Phone IS: Email Address:.
Attach additional Nips if necessary.
I fluadere Stmeineht• '• , • , - .: 4 • . •
The signer of this statement,:Artif Who%they wattle Owners of the parcel referenced herein,that they are nor onset,
contractors and that they will be assuming tha respo 4,511:11ity of the General Contractor far the proposed project.
, Signature: Print Name: Date! •
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