HomeMy WebLinkAboutBLD2000-00490 t ,
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BUILDING PERMIT
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451 (800) 831-2678
PERMIT #: BLD00-00490 Received Date 07/26/2000
SITE ADDRESS: 464 BACHELOR RD Issue Date 07/26/2000
GARDINER, 98382 Expiration Date 07/26/2001
APPLICANT: GORDON ANDERSON PHONE: (612)940-8791
2445 ARONA STREET
ROSEVILLE MN 55113
SUBDIVISION: WM H THOMAS SHORT PLAT Block: Lot: 2
PARCEL NUMBER: 002341012 Section: 34 Township: 30 N Range: 02 W
CONTRACTOR: OWNER PHONE:
LOAN LENDER/
BOND HOLDER:
PROJECT DESCRIPTION STAIRWELL INSIDE EXISTING BUILDING
REQUIRED INSPECTIONS:
[ ] Footings/Setbacks (Shoreline Setbacks):
[ ] Foundation:
[ ] Underground Plumbing/Underground Insulation:
[ ] Shear Wall:
[ ] Fri /Plumbing: 6C �:, C- E �
[ ] Propane Tank/Lines:
[ ] Insulation:
[ ] , Sheetrock:
nal/Occupancy App ro��L 1 ii`N (; '
HEALTH DEPARTMENT APPROVAL REQUIRED PRIOR TO FINAL INSPECTION.
THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED
BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS.
Office Hours 9:00 a.m. -4:30 p.m.
Inspector's Phone Hours 8:00 a.m. - 9:00 a.m.
SPECIAL CONDITIONS MAY APPLY - SEE REVERSE
HOT LINE AVAILABLE 24 HOURS A DAY
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BUILDING PERMIT APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD00-00490 Received Date: 7/26/2000
SITE ADDRESS: 464 BACHELOR RD
GARDINER, 98382
APPLICANT: GORDON ANDERSON PHONE: (612)940-8791
2445 ARONA STREET
ROSEVILLE MN 55113
SUBDIVISION: WM H THOMAS SHORT PLAT Block: Lot: 2
PARCEL NUMBER: 002341012 Section: 34 Township: 30 N Range: 02 W
CONTRACTOR: OWNER PHONE
ARCHITECT/
ENGINEER :
PROJECT DESCRIPTION: STAIRWELL INSIDE EXISTING BUILDING
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP ALT MAIN:
VALUATION 550.00 ADD'L: HEAT TYPE: UH
CODE EDITION: 1997 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM: PUD PARCEL TAGS: YES NO
BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA
Exist: Exist: Wetland Erosion
Prop: Prop: Seismic Streams
Total: Total: Flood Way Flood Plane
F&W Landslide
Routing Date: ''`� _ Shoreline Aquifer
Forest: Commercial Rural
1-'r ximityV - Plat Coq❑❑ditions
Type Amount Paid By: Date: Receipt: Approved/Uate
Permit $38.75 MAM 07/26/00 33319 f ED
Plan Check $11.63 MAM 07/26/00 33319
State Building Code $4.50 MAM 07/26/00 33319 U CQn
Total: $54.88
Jefferson County Planning
&Building Department
is\F_BLD_App_Bld.rpt 10/29/99
' Jefferson County Department of Conaway 06V9101MUlt
e.sort cow 821 Sheridan Street.Port Townsend Wit 88388 378-4450
App -ocatoon
Project Description:
Building Type: P ject Type: ame Type:
= Single Family New Wood
Garage Attached/Detached _ Addition 2 Steel
Modular = Alteration/Remodel Concrete
= Commercial = Repair 2 Masonry i
= Multi-family/#of Units = Demolition 2 Other:
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Industrial
Other. Adj:4 STG{l,�(.UBedrooms: Bathrooms: I Type of Sewage Disposal: Type of Heat:
iChoose one:
Existing: Existing: = Sewer =Community System 2 Electricity = Oil
Proposed: Proposed: = Individual System 2 Woodstove 2 Propane I
Total: Total: If not sewer,fill out the following: Heat Pump
= Conventional '5LAlternative 2 Other
Permit # SEP
Water Supply:
Private well 2 Two Party Well 2 Public:Name of water system: 047
Square Footage: For Office Use Only
Main Floor UBC OCCUPANCY GROUP
2i`'n Floor I Base fee ..3%r
3i-i Floor i Plan Check fee t 1 . ' 3
,
Htd Basement State Surcharge fee Li 0
Unhtd Basement Subtotal
Garage/Carport Pot Water Review fee ti.-(
Decks 911/Rd Approach fee - --
Commercial TOTAL
Industrial �~��' �-, Receipt # s . /9
Other k Cash/Check# V 3
Total V lion: ($'ss.0. o a Initials Y
Or Date -7 ---) 6 --- -)L
Estima d Cost:
If wit ' 00' of the Sho
Distance to B or r 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,inrPrnnify 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 lacer inspections.
Access and right of entry to the applicant's property or structure shall be requested and shall occur during regular business hours.
Signature: ieryn/X1) 4kieee4A--1-` Date: 7/o2/D d
yorr Jefferson County Department of'Community Development
-0 621 Sheridan Street,Port Townsend WA 98368 (360) 379-4450
*ti
\'% - Universal Plot Plan
Fill in the following blanks as completely as possible :
Project Dparin ion:
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9 Digit Parcel Identification Number (from your tax statement):
42 / /
Site Address
911.: L/! 4 Road Name: 6A_ 61_0 4 Zip Code:
Legal Description
Subdivision Name: a)pi y t m• - Block: Lot(s):
Section: Township' i Range:
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Parcel Size (acres or square footage): ? << z 0
Property Owner: s-, Phone:
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Meiling Address: J
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Applicant/Occupant: Phone:
(if different from owner)
Mailing Address:
Authorized Rep: Phone:
Mailing Address:
General Contractor:
Or Manufactured Home Installer: C), vC. j L� , k. Phone:
Mailing Address:
Contractor's State License Number. Expiration Date:
Septic Designer:
Phone:
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Mailing Address: +'
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Architect:/Engineer: ''
iPhone:
Mailing Address:
`�'General �� Phone:
Contractor's Bond Holder:
FOR OFFICE USE ONL Y
Fire District: Planning Area: I School District: Zone:
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