HomeMy WebLinkAboutBLD2000-00363 r
1! ' ' ,BUILDING PERMIT APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD00-00363 Received Date: 6/5/2000
SITE ADDRESS: 8863 FLAGLER RD
NORDLAND, 98358
APPLICANT: DENIS DIGNAN & CAROL BANGS PHONE: (360)385-0688
8863 FLAGLER RD
NORDLAND WA 98358
SUBDIVISION: ORME SHORT PLAT Block: Lot: 1
PARCEL NUMBER: 953700322 Section: 20 Township: 30 N Range: 01 E
CONTRACTOR: OWNER PHONE: I
ARCH ITECT/
ENGINEER :
PROJECT DESCRIPTION: DECK
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP ADD MAIN:
VALUATION 5,280.00 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: 528 SETBACK: 110
BANK HEIGHT: 80
SEWAGE DISPOSAL: CON
WATER SYSTEM: PWELL PARCEL TAGS: YES NO
BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA
Exist: 2 Exist: 2 Wetland Erosion
Prop: Prop: Seismic Streams
Total: 2 Total: 2 Flood Way Flood Plane
F&W Landslide
Routing Date: Shoreline Aquifer
Forest: Commercial Rural
—I-'r xlmlt - Flat Conditions
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $125.25 MAM 06/05/00 31653
Plan Check $37.58 MAM 06/05/00 31653
State Building Code $4.50 MAM 06/05/00 31653
Total: $167.33
I:\F_BLD_App_Bld.rpt 10/29/99
'Jefferson Canty i i:.i artment of Community ileveiopitient
,ct..es, sON G 621 Sheridan Street.Port Townsend WA 98368[3601379-4450
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Project Description:
Building Type: Project Type: Frame Type:
Single Family = New ✓Wood
Garage Attached/Detached a/Addition Steel
Modular = Alteration/Remodel 2 Concrete
Commercial 2 Repair 2 Masonry
Multi-family/#of Units = Demolition 2 Other.
Industrial
.''Other. 0 e.a.
Bedrooms: Bathrooms: ' Type of Sewage Disposal: Type of Heat:
Choose one: 1
Existing: a Existing: Sewer :Community System Tr Electricity li Oil
Proposed: —^ Proposed: ;(Individual System 2 Woodstove = Propane
Total: a. Total: If not sewer,fill out the following: 2 Heat Pump
;i'Conventional 2 Alternative Other
Permit# SEP
Water Supply:
V Private well Two Party Well 2 Public:Name of water system:
Square Footage: ' For Office Use Only P?
Main Floor UBC OCCUPANCY GROUP
2ND Floor Base fee f S'
S
3rd Ficor Plan Check fee _. S 7•S
Htd Basement State Surrhnrge fee 5 v
Unhtd Basement - Subtotal /6 7`33
Garage/Carport Pot Water Review fee `�—
D /-'0
ecks 5a.$ 5%. k��'C 911/Rd Approach fee -FS"
Commercial TOTAL I (a 7- 3 3
Industrial Receipt # „3/
Other Cash/Check# '79 3Q,
Thtal Valuation: - Initials (A _ _,. _ '1
Or
Date 9 —S-On
Estimated Cost:
If within 200' of the Shoreline,
Distance to Bank or Ordinary High Water Mark l i 0 CI, ft.Bank Height it 0 fr.
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,indr,mnify 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. /osi -ou()
Siaature: aCVWId_ _ �,t,h Date: 0 (0
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Jefferson County Department of Community Development
�/-��oN co 621 Sheridan Street,Port Townsend WA 98368 (360) 379-4450
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Universal Plot Plan
Fill in the following blanks as completely as possible :
Project Description:
Woo 6.. (k4e..0 9 oaTa-1(ve.ck- "lb •ex.\s 1 i r IA uks e-
9 Digit Parcel Identification Number (from your tax statement): 9 S 3 ` 70 O _ 3 a a.
Site Address
911#: $$(93 Road Name: FtaII\tr Rr), , Zip Code: g 835s-
Legal Description `
Subdivision Name: o2ME 3#-I-DRT PLAT Block: Lot(s): I
Section: 2-0 Township: 3 p N Range: l Ea S.1-
Parcel Size (acres or square footage): a. ,e.
Property Owner: Phone:
t>�ekNis D;sv.av, / CAROB., 13A-1.1 .s 3(n0 — 38S-6C$Fs
Mailing Address: `b S(a 3 1 \O-J '' Rd_. hut-6,l 0.3+\d., W A R g3sTs
Applicant/Occupant: Phone:
(if different from owner) NA
Mailing Address:
Authorized Rep: Phone:
NA
Mailing Address:
General Contractor:
Or Manufactured Home Installer: NA Phone:
Mailing Address:
Contractor's State License Number: Expiration Date:
Septic Designer: A Phone:
Mailing Address:
Architect:/Engineer: Phone:
Nh
Mailing Address:
Loan Lender/General Phone:
Contractor's Bond Holder: N A
Mailing Address:
FOR OFFICE USE ONLY
Fire District: Planning Area: School District: Zone:
1/00 H:\home\pincntr\forms\universal plot plan
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