HomeMy WebLinkAboutBLD2001-00424 •
BUILDING PERMIT APPLICATION Review Type:
Jefferson County Department of Community Development '
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD01-00424 Received Date: 7/27/2001
SITE ADDRESS: 7464 COYLE RD
QUILCENE, 98376
OWNER: C LINCOLN ERWIN, JR PHONE: (360)693-6489
PO BOX 1647
VANCOUVER WA 98668-1647
SUBDIVISION: Block: Lot: 1
PARCEL NUMBER: 701341003 Section: 34 Township: 27 N Range: 01 W
CONTRACTOR: OWNER PHONE:
REPRESENTATIVE(S):
PROJECT DESCRIPTIO NO MLA REQ'D -- FOUNDATION FOR PRE-EXISTING (1966)
BUILDING
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP REP MAIN: 961
VALUATION 25,000.00 ADD'L: HEAT TYPE:
CODE EDITION: 1997 HEAT BASE: HEAT TYPE:
OCCUPANCY: R-3 UNHEATED: #OF STORIES: 1
OCCUPANCY: OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM: PARCEL TAGS: YES NO
BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA
Exist: 2 Exist: 1 Wetland Erosion
Prop: Prop: Seismic Streams
Total: 2 Total: 1 Flood Way Floodplain
F&W Landslide
Routing Date: Shoreline Aquifer Forest: Commercial Rural
Proximity Plat Conditions
Type Amount Paid By: Date: Receipt: Approved/Date
Total: APP • i)
AUG 0 .9 2001
JEFFERSON COUN
DEPT.OF UNI PMENT
SIGNAT E: �' ,
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'DEPARTMENT OF COMMUNITY DEVELOPMENT
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�$ " . 621 Sheridan Street • Port Townsend • Washington 98368
�7Nav- 360/379-4450 • 800/831-2678 • 360/379-4451 Fax JEFFERSON COUNTY
DEPT.Of COMMUNITY DEVELOPMENT
BUILDING PERMIT APPLICATION
Project Description:
Building Type: Project Type: Frame Type:
❑ Single Family 0 New ❑ Wood
❑ Garage Attached/Detached El Addition ❑ Steel
• Modular Alteration/Remodel ❑ Concrete
Li Commercial ❑ Repair ❑ Masonry
❑ Multi-family/#of Units ❑ Demolition ii Other.
❑ Industrial
Other:
Bedrooms: Bathrooms: Type of Sewage Disposal: Type of Heat:
Choose one:
Existing: Existing: ❑ Sewer Li Community System ❑ Electricity ❑ Oil
Proposed: Proposed: ❑ Individual System ❑ Woodstove ❑ Propane
Total: Total: If not sewer,fill out the following: ❑ Heat Pump
Conventional ❑ Alternative ❑ Other
Permit# SEP
Water Supply:
❑ Private well EJ Two Party Well❑ Public:Name of water system:
Square Footage: / For Office Use Only
Main Floor ,d,j0
UBC OCCUPANCY GROUP ._--
�r
2ND Floor Base fee // Z
3rd Floor ! Plan Check fee /_/(/ �� x�
Htd Basement State Surcharge fee ) (J
Unhtd Basement Subtotal/ 3 , / 3
Garage/Carport Pot Water Review fee _
Decks 911/Rd Approach fee -&
Commercial TOTAL r/
Industrial Receipt#
Other Cash/Check#
Total Valuation: Initials
Or Date
Estimated Cost:
If within 200' of the Shoreline,
Distance to Bank or Ordinary High Water Mark ft. Bank Height ft.
By signing the application form,the applicant/owner attests that the information provided herein is true and correct to the best of their knowledge. Any material falsehood or any
omission of a material fact made by the applicant/owner 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 attomey'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 it's employees,representatives or agents for the purpose of application review and any required later inspections.
Access and right of entry to the applicant's property or structure shall be requested and shall occur during regular business hours.
Signature: Date:
H:HOME\PLNCNIR\IN FOBLDG\FORMS\BLDpermitApplication l/2000
• •
Stormwater Calculations
IMPERVIOUS SURFACE
NEW EXISTING Structures (all roof area) sq/ft Structures (all roof area) _ 9/0 sq/ft
Driveway sq/ft Driveway sq/ft
Sidewalks sq/ft Sidewalks sq/ft
Patios sq/ft Patios sq/ft
Solid Decks sq/ft Solid Decks sq/ft
Other sq/ft Other
// , sq/ft
Total New sq/ft Total Existing 9 V ,;q/ft
•
TOTAL NEW+TOTAL EXISTING* 970 sq/ft
*This amount will be used to check total lot coverage
Please also indicate the amount of land disturbing activity, in addition to the creation of impervious surface, that will take
place:
LAND DISTURBING ACTIVITY
Drainfield area cleared sq/ft Well, Structures, Utilities, etc. 9/0 sq/ft
Driveway sq/ft Other sq/ft
Total Land Disturbance < (i sq/ft
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