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Home My WebLink AboutBLD2020-00519-MINOR REMODELDate: 10/6/2020 Invoice ID: 2020BLD20-00519 JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street | Port Townsend, WA 98368 360-379-4450 | email: dcd@co.jefferson.wa.us www.co.jefferson.wa.us/commdevelopment Invoice Date Due: 11/5/2020 REMIT TO: BILLING ADDRESS: Please return the above portion with your payment Permit 192.00 Tech Fee 11.13 Scanning Fee 24.00 State Building Code 6.50 $233.63Total Amount Due: Jefferson County DCD 621 Sheridan St. Port Townsend, WA 98368 LAUREEN ELIZABETH PORT TOWNSEND WA 98368 51 MOLENDA LN Permit Number: BLD20-00519 Permit 192.00 Tech Fee 11.13 Scanning Fee 24.00 State Building Code 6.50 Total Amount Due:$233.63 Payment is accepted by cash, check, debit or credit card (Visa, Mastercard, Discover). To pay by credit card, go to http://www.co.jefferson.wa.us/617/Credit-Card-E-Check-Payments-for-Permits, and click on the "Online Credit Card & echeck Payments" link on the left side of the page. For questions: call 360-379-4450. Permit Application Page 1 of 2 DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street, Port Townsend, WA 98368 Tel: 360.379.4450 | Fax: 360.379.4451 Web: www.co.jefferson.wa.us/communitydevelopment E-mail: dcd@co.jefferson.wa.us 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: Site Address and/or Directions to Property: Access (name of street(s)) from which access will be gained: Present use of property: Description of Work (include proposed uses): Wastewater - Sewage Disposal This property is served by Port Townsend or 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: 947400066 51 MOLENDA LN, PORT TOWNSEND 98368 ZĞƉůĂĐĞ1ǁŝŶĚŽw.EŽƐŝǌĞͬƐƚƌƵĐƚƵƌĂůĐŚĂŶŐĞƐ͘tŽƌŬǀĂůƵĞΨϭ046.40 Honeymoon Ln to Fagerhill Rd to Molenda Ln. Permit Application Page 2 of 2 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: Address: Phone #: E-mail Address: Please contact Authorized Agent/Representative with project info. (select only one). Property Owner Signature: 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: Address: Phone #: E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: License # Address: Phone #: E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: License # Address: Phone #: E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: License # Address: Phone #: E-mail Address: 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. 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: LAUREEN ELIZABETH 51 MOLENDA LN͕WŽƌƚdŽǁŶƐĞŶĚϵϴϯϲϴ 860-669-7366 ƐĞĞĂƚƚĂĐŚĞĚĐŽŶƚƌĂĐƚ y dŚĞ,ŽŵĞĞƉŽƚ ,KDΎΎϬϴϴZ, ϯϬϬ,hd^tz^^dϯϬϰ͕KůǇŵƉŝĂtϵϴϱϬϭϰ ϯϲϬͲϵϰϱͲϮϳϴϳ ŶĂŝĚĂΛŶǁƉĞƌŵŝƚ͘ĐŽŵ EĂŝĚĂ<ŚĂŶͬEŽƌƚŚǁĞƐƚWĞƌŵŝƚ/ŶĐ͘ ϭϬϮϲ^tϭϱϭƐƚ^ƚƵƌŝĞŶtϵϴϭϲϲ ŶĂŝĚĂΛŶǁƉĞƌŵŝƚ͘ĐŽŵϯϲϬͲϵϰϱͲϮϳϴϳ EĂŝĚĂ<ŚĂŶͬEŽƌƚŚǁĞƐƚWĞƌŵŝƚ presentatives or agents of the County’s intent to 10/5/2020 Supplemental SFR 1 DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street, Port Townsend, WA 98368 Tel: 360.379.4450 | Fax: 360.379.4451 Web: www.co.jefferson.wa.us/communitydevelopment E-mail: dcd@co.jefferson.wa.us SUPPLEMENTAL APPLICATION RESIDENTIAL OR COMMERCIAL BLDG PERMIT For Department Use Only Receipt #: Date: Related Application #s: Payment #: Site Information Owner Name:Assessor Tax Parcel #: Type of Building New Replacement Relocated Addition Repair Demolition * *A separate permit is required Select One: Single Family Residence Modular Other list Proposed Building/Project Number of floors # new bedrooms existing total bed # new bathrooms existing total bath Heat Source Select all that apply: Electric Heating Oil Wood Propane Enter the square footage (sq/ft) that applies in each field: Structure Existing Sq/Ft Proposed Sq/Ft ICC Valuation (Office Use) 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): $ $ LAUREEN ELIZABETH 947400066 ✔ ✔ $ 1046.40 Supplemental SFR 2 List existing buildings on property (i.e. house, garage, accessory dwelling unit, shed, barn, mobile home, other): All Existing Buildings on Property Use 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: _____________ 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. Signature: Print Name: Date: For Department Use Only Building Permit Fees Building Base Plan Check Review Land Use Review $288.00 Septic Review $139.00 Potable Water $139.00 Technology/Scan $24.00 State Fee $6.50 Other Fees Shoreline Exemption Zoning Zoning Other New Address Technology Fee – 5% Total Fees Receipt # Date: Cash/Check/CC: Naida Khan Digitally signed by Naida Khan Date: 2020.07.20 20:28:00 -07'00'Naida Khan/Northwest Permit INc.10/5/2020 HDE Seattle (Renton) 3600 Lind Ave SW Ste 150 Renton, WA 98057-4934 Quote Number: SQPEVI021463_1 Print Date: 9/26/2020 Page 1 of 2 Quote Name:11009115 ELIZABETH Quote Number: SQPEVI021463_1 Customer:HDE Created Date:9/26/2020 Payment Terms:Modified Date:9/26/2020 PO Number:Sales Representative:Krystal Byrd Mobile: krystal_byrd@homedepot.com Total Windows:1 Weighted Average:U-Factor: .29, SHGC: .29, VT: .55 Total Doors: Total Sq Ft:16.00 Total Perim Ft:17Comments: Est. Delivery:____________________ Billing Information Shipping Information Name: HDE Name: Address: , Address: , Phone:Phone: Fax:Fax: Email:Email: Line: Quantity: 1 1 Location: BED Trinsic, 2110, HV, No Fin (Block Frame), Ext White / Int White, U-Factor: .29, SHGC: .29, VT: .55 Energy Star North-Central No Fin (Block Frame) Argon Gas Filled Tariff Model = Half Vent Size = Net Frame: 47 3/8" x 47 3/8" Handing = XO Energy Package = Energy Star North-Central Glass = 3/32" SunCoat (Low-E) over 3/32" Clear with Gray EdgeGardMAX Spacer Glazing = Dual Glaze with Argon Hardware = SmartTouch Lock Screen = Standard with Fiberglass Mesh Ratings = STC: No Rating, OITC: No Rating, PG: LC25 Clear Opening = W 21 5/16" x H 44 7/8" Sq. Ft. 6.64, Egress: Yes Other Ratings = CPD: MIL-A-294-02289-00001 Viewed From Exterior Customer Approval:____________ Quote Number: SQPEVI021463_1 Print Date: 9/26/2020 Page 2 of 2 HDE Seattle (Renton) 3600 Lind Ave SW Ste 150 Renton, WA 98057-4934 Submitted By:___________________________ Accepted By:___________________________ Date:___________________________ For warranty information please visit www.milgard.com/warranty/ Please note that actual NFRC energy values may vary from those reported in CTB Quote Plus due to variations that may occur during the manufacturing process. In most cases variations will be minimal. Please contact your Milgard location with questions or concerns regarding this potential variation. Handing is viewed from outside looking in. ADDITIONAL INFORMATION: