HomeMy WebLinkAboutBLD2006-00319 - WITHDRAWN 06-
BUILDING PERMIT APPLICAAN MRL Review Ty
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Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD06-00319 Received Date: 6/7/2006
SITE ADDRESS: 280 FOREST DR
BRINNON, 98320
OWNER: CHARLES 0 CARROLL PHONE: (360) 796-0191
BARBARA J CARROLL
280 FOREST DR
BRINNON WA 98320-9635 WILLIAMS ADDITION
SUBDIVISION: Block: 1 Lot: 19+
PARCEL NUMBER: 932900112 Section: 31 Township: 25 N Range: 02 W
CONTRACTOR: SOUND BUILDING SYSTEMS PHONE: (360)437-1219
3546 THORNDYKE RD
PORT LUDLOW WA 98365-8229
Contractor's License SOUNDBS027NM Expires 08/19/2006
REPRESENTATIVE: SOUND BUILDING SYSTEMS INC PHONE: (360)437-1219
3546 THORNDYKE RD
PROJECT DESCRIPTION NEW POLE BUILDING/GARA.GE - NO HEATING - NO PLUMBING
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION 13,910.00 ADD'L: HEAT TYPE: UH
CODE EDITION: 2003 HEAT BASE: HEAT TYPE:
OCCUPANCY:
OCCUPANCY: UNHEATED: #OF STORIES:
OTHER:
CONST TYPE: GARAGE: 864 SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: PUD
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total: Total:
Routing Date: (Pict/ 0(c
Type Amount Paid Bv: Date: Receipt: Approved/Date
Permit $236.25 KAS 06/07/06 83459
Plan Check $154.21 KAS 06/07/06 83459
State Building Code $4.50 KAS 06/07/06 83459
Total: $394.96
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` DEPARTMEN COMMUNITY DEVELOPMENT
621 Sheridan Street • Port Townsend •Washington 98368
•. I
360/379-4450 • 360/379-4451 Fax H — 2006
.qS, p� www.co.jefferson.wa.us/commdevelopment
8TN ,
Master Permit Application MLA: IJIQ ='� 9
Project Description (include separate sheets as necessary): — — -
ecns trkctiart el' .2•1' X 3re 'x iC' pole J
buileltn'yJ ,,—"e=
Property
Tax Parcel Number: 5 3.2 - y oo -- r 12 Size: SDI 3 k (acres square feet)'
Site Address and/or Directions to Property: ako For e s t £ r, v, , ,(j,-,„„o et
Property Owner(s)of Record: C h a r l e s ? Rar 6.ra C u roil
Telephone: _;1o0 - -1 94, - v 1 q I Fax: email:
Mailing Address: ) 'o (-ore,t fr,u� , ir, nncn t&.'A ¶S3:i0
Applicant/Agent(if different from owner): S o u„d A k E IeL 9 5 y s fie M. T h,
Telephone: 360 1i3-?-/..i tt Fax: 3 ico- Li 7-,,2 i b email:
Mailing Address: 35' 6 I7iorrtdyke Road, Port L,A(cc.,t t. 'A 9&31,;
Wh t kind of Permit?(Check each box that applies)
tuilding 0 Variance(Minor, Major or Reasonable Economic Use)
❑ Demolition Permit 0 Conditional Use[C(a), C(d),or CI**
❑ Single Family 0 Discretionary"D"or Unnamed Use Classification
III-Garage Attachecetached i 0 Special Use(Essential Public Facilities)**
0 Manufactured Home 0 Boundary Line Adjustment
❑ Modular 0 Short Plat**
❑ Commercial* 0 Binding Site Plan**
0 Change of Use 0 Long Plat**
❑Address 0 Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments**
0 Propane 0 Plat Vacation/Alteration**
❑ Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions**
❑ Stormwater Management 0 Shoreline Management Substantial Development**
0 Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Variance
0 Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment
0 Wireless Telecommunication* 0 Jefferson County Shoreline Master Program Amendment
0 Forest Practices Act/Release of Six-Year Moratorium
*May require a Pre-Application Conference **Requires a Pre-Application Conference
Please identify any other local, state or federal permits required for this proposal, if known:
DESIGN TION OF AGENT
I hereby designate ; • 1 y agent in matters relating to this application for permit(s).
0
OWNER SIGNATURE ' p '-. r Date: r;— — (DI()
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 it's 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 this permit being null and void.
I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and
expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit.
I further 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 inspecti s.Access and right of entry to this property shall be requested and shall occur only during regular business
hours.
Signature: �/ Date: — 7 -0 6
The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or
endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the
"Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit
has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)
even if you are in compliance with he Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-
transferable re n2s' ility fora ring to and com I in .h the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature�� Date: c� -- 7 -•b 6
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc
I
• BUILDER STATEMENT •
The signer of this statement does hereby certify 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: Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
5o..rtd 6u,1c1h.,i SySleh v a
s Inc, ( 3� ) Lin - l19 ( 34-o ) °/3 7_ 1101
MAILING ADDRESS: / � EMAIL:
,35 v& ' iior✓,cl y ke_. Rowel
CONTRACTORS LICENSE fort L.�,,i I ow, l,l)'Q 1 y3(c5 WAINS
NUMBER: S O U ki Q a G�.7 iv NI
NUMBER
ARCHITECT/ENGINEER: A PHONE ( 5-03) S-�`i-!Y�7 FAX: (So3 )S. q- •la, a-
MAILING ADDRESS: ,27c0 ,I,IQ,kcf sr• NE St'e 4 Sk le„.. c 1.? 4-7 30 1 EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
[ New P---Wood Existing: 1.1 Sewer
❑ Addition ❑ Steel Proposed: _0 Bank Height: ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: 1lndividual System
❑ Repair ❑ Masonry SEP Permit#
Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: (I Private well EL Two Party
Type of Heat: Proposed: -0 1 1 Public
Total: Name of System: Pub # I
SOYt L.a w„f
If this is a Commercial Project you must answer the following:
Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces:
Number of occupants (includes owners,tenants,employees,etc) Current Proposed
IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No
If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply:
Li Underground Tank i I Above ground Tank Size of Propane Tank:
11 Heat Stove ❑ Cook Stove Li Woodstove I 1 Fireplace Insert L i Hot Water Tank ❑ Pellet Stove ❑ Other
Is this appliance being installed in a Manufactured/Mobile Home? Yes / No
When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property
lines, tank location and size, distances from the propane tank to all property lines, buildings and septic system components,
including the reserve area.
Square Footage Current Proposed For Office Use Only Amount Revision
Main Floor Heated EH Bld App Review: (S(5
2n0 Floor Heated Consistency Review: I J
Other Heated Base fee: ,j 5 L)t R�
Mezzanine Additional Section:
Heated Basement Plan Check fee: I
Unheated Basement State Surcharge fee: G,
*-4 r
Other Unheated Pot Water Review fee:
Garage/Carport ,4 SUBTOTAL
,� 13,110. 0
Decks 11/Rd Approach fee:
Other 17::::—.\
TtTAL: $ I XI 6)
1 Receipt Number: — 33 IA 5 G
! Cas(;/ 1eck/lugtr: t c
ESTIMATED COST(REQUIRED) Date: / t
.Fair,,market value of all labor and materials foundation to finish I ( 1 00
Initials: , N
bc1C
/ 3 J , 6 0 L. -------
G:\PermitCenter\F ORMS\DRD FORMS\Master Permit Application 12-30-05.doc
s •
August 25, 2006
To Whom It May Concern, 1 E
CEINTAT
Please withdraw our pole building/garage permit. l" 2 3116
8
BLD 06-00-319
Thank You. d iC
Sincerely,
Charles�� � O. Carroll
(1 (e ms
PBarbara6ci../zGt....J. Carroll
at ( vo-a