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Home My WebLink AboutBLD1999-00694 2cA D . .? V. GOUSi.. E. BANn o' ANGE SURvt-`/ TAPE ;.6, r1Ar2KS P20POSE ': T3LD (r SITE r GAPE GEor2 :& dZo :II .± I:T;T- /'/ ` J� W - 3 o i i , , 7 ,,,Ajii ,>\ I nN ALI`r;,eA 1GN'/2�/'fene z. 1 hh rc 6-11-e % J C) N i \ i.,oC �oN OF `‘'°\ SEpTlIC AN'' '1" \ —c. .., d 7 .----1 ,--'-•-•N to 44__H ic-C AL-N\T I C\A:: r,�%% PT,y.•Ai ii...,..,, •••". 91". —... 81.. - ' / I OF WELL- u 1 or��tl�A� `'' `! PR. Stra1 BoA1T 6 _ C-- lsk.o p X , - RV SNEn 1.11 ! \ -.. ! i 02 2. r~ 1 , Jefferson County Permit Center * Department of Community Development 621 Sheridan Street Port Townsend WA 98368 (3601379-4450 Up.rversrc de id/44,6o? dlagad a4 eastgetelet a4 Atutdiele: Project Description: `.--/='e c'-r /fGi 5,e/9-7-/G '//'GNC' DES 9 Digit Parcel Identification Number (from your tali statement): COL 073 QC4-- Site Address 911#: 2153 Road Name: C/`��C C-��"%'�i-�" �'Q Zip Code: `9e, 36e Legal Description Subdivision Name: /Li /A4' ! Block: Lot(s): Section: 5 7 Township: r 3c Range: ,C1 Parcel Size (acres or square footage): /<<- `. 7�S Property Owner: " , Phone: Mailing Address: „ _ Applicant/Occupant: Phone: (if different from owne ) Mailing Address: Authorized Rep: it/,4 Phone: Mailing Address: General Contractor: Or Manufactured Home Installer: G GU/L r Phone: Mailing Address: Contractor's State License Number: Expiration Dare: Septic Designer: ;L /� i Phone: a Mailing Address: Architect:/Engineer: {,,/� i Phone: Mailing Address: Loan Lender/General _ j Phone: Contractor's Bond Holder: ( G(.'� �� Mailing Address: FOR OPPICE USE ONLY Fire District: 6 Planning Area: School District: 14 Zone: 4/98 H:\home\pincntr\forms\universal plot plan a , SON coG Jefferson County Permit Center . . Department of Community Development 1. al •\�\ 621 Sheridan Street,Port Townsend WA 88368(3601318-4450 ti •a 1-C'11 ?Derail-II S NHS AM:CtiVen Project Description: Building Type: Project Type: Frame Type: ❑ Single Family ❑ New • X Wood X. Garage Attached/Detached ❑ Addition ❑ Steel ❑ Modular XI Alteration/Remodel 2 Concrete ❑ Commercial ❑ Repair ❑ Masonry ❑ Multi-family/# of Units ❑ Demolition Other. ❑ Industrial Other: Bedrooms: ' Bathrooms: Type of Sewage Disposal: Type of Heat: Choose one: Existing: 1 Existing: _1— ❑ Sewer ❑Community System ,,;Electricity : Oil Proposed: 0 Proposed: 0 X Individual System 7. Woodstove Propane Total: _ Total: / If not sewer,fill out the following: 2 Heat Pump Conventional ❑ Alternative 1 2 Other PFLLC I 57CvE Permit # SEP 97 -C/67 Water Supply: X. Private well 2 Two Party Well Public:Name of water system: ` Square Footage: 1 For Office Use Only . Main Floor C C C UBC OCCUPANCY GROLP2S:LC- V l0LA-110N I 2ND Floor Base fee I ZS.Z. 3rd Floor Plan Check fee —) . S g Htd Basement State Surcharge fee 4 . Sb Unhtd Basement /4 C (: Subtotal 2q 2 , SS ----*Garage/Carport G ) Pot Water Review fee Decks 911/Rd Approach fee Commercial TOTAL 2-9 2.. S Industrial Receipt # i qq ZJc Other Cash/Check # CA S4 Total Valuation: (006 Initials LlSi8 Or Date LO• (-•CjC Estimated Cost: 3 O'6 If within 200' of the Shoreline, , Distance to Bank or Ordinary High Water Mark N l ft. Bank Height ft. Signature: ,,!�-di. � `�i Date: /3 Cc % /99 r , } r r JEFFERSON COUNTY BUILDING APPLICATT9N Jefferson County Permit Center Castle Hill Mall 621 Sheridan St . Port Townsend, WA 983f8 360-379-4450 PERMIT # •BLD99-0694 DATE RECEIVED. :10/13/99 SITE ADDRESS :2153 CAPE GEORGE RD :PORT TOWNSEND, WA 9838 APPL-II''fiNT. _-:ROB `•RT VORSBERG - PHONE.:3-85_-Q 2 6 MAI-LING- 71DDR:215 0- CAPE-- GEORGE- RD :PORT TOWNSEND- WA 9-8-A68 r CONTRACTOR.. . :OWNER- PHONE: MAILING ADDR: CONTR. LIC W: EXIIRATION DATE--: / / - ARCHITECT/. . : PHOjE: DESIGNER,. . . : MAILING ADIR: PARCEL NO. :00107-3-00-4- Landslide-- Plat Fond-- Wetland- Flooding LEGAL_ DFSC:STR0.7-3Q-Ql. W WM Seismic Streams Erosion F & W LOT 4,_ BLOCK , TAX # Shoreline Aquifer. — Area Com. Forest: Adj. 300 ' DESCRIPTION OF IMPROVEMENT: garage alteration/remodel r BTL NG---'r YPE •GAR- BEDROOM --- RATWROOMS-- MAI.N-- FL-, . . : 0. s f TYPE OF IMPROVEMENT:ALT EXIST-. : 1 EXIST.. : 1 ADD' L- FL-. . : 0--sf GARAGE/CARPORT PROP-. .. :- 0 PROP 0 HTE -B MT. : -0 `s f WOODSTOVE____. . . _ , . . . TOTAL. : 1 TOTAL. : L UNHT BSMT._ 0 sf UBC OCCUPANCY GROUP: SEWAGE DISP. . :CON OTHER 0 _pf TYPE OF CONST WATER SUPPLY. :PWELL CRPT/GAR. . : 600 sf UNITS . : 0 STORIES : 0 HEAT TYPES :Erg DECKS 0 _sf DIMENSIONS: A COMMERCIAL: 0 sf FRAME TYPE:WOOD INDUSTRIAL: 0 f EST COST. $ : 6000 BANK HT. . . : 0 -Et PROJ GRP. . : 9438 SH SETBACK: 0 ft Owner/agent FEES Signature: C 0 type amount by date recpt L PRMT $- 125.25 LMB- 10-/13-/9 9 19- 2 6 Date: PP P B VIOL $ 125 .25 LMB 10/13/99 19926 Issued By: 1g /( PLCK $ 37 .58 LMB 10/13/99 199126 '� 9 B.C. $ 4 .50 LMB 10/13/99 19926 L Date: n n y Planning (bld_appl .txt 4/981 &e�s•cn5ngpe artment $ 292 .58 TOTAL • i JEFFERSON COUNTY BUILDING PERMIT Jefferson County Permit Center Castle Hill Mall 621 Sheridan St . Port Townsend, WA 98368 360-379-4450 PERMIT # •BLD99-0694 DATE ISSUED. : 10/20/99 SITE ADDRESS :2153 CAPE GEORGE RD : PORT TOWNSEND, WA 98368 APPLICANT. . . :ROBERT FORSBERG PHONE : 385-0626 MAILING ADDR:2150 CAPE GEORGE RD : PORT TOWNSEND WA 98368 CONTRACTOR. . :OWNER PHONE : MAILING ADDR: CONTR. LIC # : EXPIRATION DATE : / / LOAN LENDER. : MAILING ADDR: • PARCEL NO. . . : 001073004 LEGAL DESC. . :STR 07-30-01 WWM, TAX # LOT 4 , BLOCK , DESCRIPTION OF IMPROVEMENT: garage alteration/remodel ( ) Footing/Setbacks (Shoreline Setback) : ( ) Foundation: ( ) Underground Plumbing/Underground Insulation: ( Fuming/ lumbing/Chimney: ( ) Insulation: ( ) Sheetrock: ( °1141111100ccupancy Approval : AVA ar 'r - 0 Addir r 0 (bld_prmt .txt) THIS PERMIT IS VALID FOR ONE YEAR. 24 Hour Recorder for Inspections CALL 379-4455 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS Office Hours 9 a.m. to 4 : 30 p .m. Inspector' s Phone Hours 8 - 9 a Jefferson County Permit Center Date 621 Sheridan Street Fee Port Townsend WA 98368 Rec # CRITICAL AREAS QUESTIONNAIRE Ck # Case # r o Applicant Name G'(3 /�% /�/ f O.E�S_8, %,-' 2/ 3 9/025 E-02 < —mow 95368 X Building Application Land Use Application Shoreline Application On-site Sewage Application _ Subdivision Application _ Other: 1 . Is there any standing or running water on the surface of the X' YES NO property or on any nearby property at any time during the year? If YES, please describe: i4 i Pok0 2. Has any portion of the property or any nearby property ever been A( YES NO identified as a wetland or swamp? If YES, please describe: Pe xi T r)6,4)0 /7/45 &E e=A) ,17),EN r'/i r eo 45 ait i /0 3. Are any willows, skunk cabbage, alders, or cottonwoods present X YES NO on your property or adjacent properties? If YES, please describe: /-I L i)E,e S GN r7/CG P - 5(U'9/i',p LL 4a/S /?DJ,I cEN jQ f brn) 4. Are there any indications on any portion of the property or on any YES NO nearby property of rockslides, earthflows, mudflows, or landslides? If YES, please describe: 5. Please indicate which line best represents the steepest slope found on your property. (Check appropriate box) 0 0 4 Q o a ❑ I i i / / / ,' i i i i i ♦ i X /////// /,, i l//I,,,-. _-,❑ /II/////. - - -- —�❑ (Questionnaire Continues on Back) 6. Does the site have steep slopes with little to no vegetation? YES ,X NO If YES, please describe: 7. Does the site contain high percentages of silt and/or very fine YES X NO sand? If YES, please describe: 8. Does the site contain ground water seepage or springs near the YES X NO surface of the ground? If YES, please describe: The applicant hereby certifies that all of the above statements and the information contained in any other transmittals made herewith are true, and the applicant acknowledges that any action taken by Jefferson County based in whole or in part on this application may be reversed if it develops that any such statement or other information contained herein is false. �� '%%�� Date �`.3 QC' � Signature FOR OFFICE USE ONLY ❑ Wetlands ❑ Seismic CRITICAL AREAS ON OR ❑ Aquifer Recharge Area (zone ) ❑ Fish & Wildlife Area 1 IMMEDIATELY ADJACENT TO SITE: ❑ Frequently Flooded Area ❑ Fish & Wildlife Area 2 ❑ Erosion El Landslide Zone: Parcel Size: Status: Comprehensive Plan Land Use Designation: Reviewed by: Community Plan: Date: