HomeMy WebLinkAboutBLD2000-00642 BUILDING PERMIT APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD00-00642 Received Date: 9/29/2000
SITE ADDRESS: 56 LEIGHBROOK LN
PORT LUDLOW, 98365
APPLICANT: MARY 0 SMITH PHONE:
56 LEIGHBROOK LN
PORT LUDLOW WA 98365
SUBDIVISION: TIMBERTON VILLAGE PHASE I Block: ? Lot: 21
PARCEL NUMBER: 998500021 Section: 17 Township: 28 N Range: 01 E
CONTRACTOR: OWNER PHONE:
ARCH ITECT/
ENGINEER :
PROJECT DESCRIPTION: COVER EXISTING DECK
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP ADD MAIN:
VALUATION 1,800.00 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: SEW
WATER SYSTEM: LUDLOW 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: U
( (A., Shoreline Aquifer
Forest: Commercial Rural
—Proximity - F-lat conditions
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $66.20 MAM 09/29/00 34384
Plan Check $19.86 MAM 09/29/00 34384
State Building Code $4.50 MAM 09/29/00 34384
Total: $90.56
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Jefferson County Department of Community Development
e4 uN °°U 621 Sheridan Street,Port Town :nd WA 08368(360)378-4450
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Project Description:
Building Type: Project Type: Frame Type:
Single Family New 4 Wood
• Garage Attached/Detached I Addition ❑ Steel
❑ Modular "A Alteration/Remodel LE Concrete
❑ Commercial I Repair i Masonry
❑ Multi-family/#of Units �, ❑ Demolition Other:
JJ�
• Industrial /? 1<43
Other: en-"e' �pr,A_ '. '
Bedrooms: Bathrooms: Type of Sewage Disposal: - Type of Heat:
Choose one:
Existing: Existing: wer I Community System I Electricity ❑ Oil
Proposed: Proposed: ❑ Individual System ❑ Woodstove i Propane
Total: Total: If not sewer,fill out the following: ❑ Heat Pump
❑ Conventional I Alternative ❑ Other
Permit# SEP
Water Supply:
• Private well ❑ Two Party Wellie Public:Name of water system: J
Square Footage: For Office Use Only
Main Floor UBC OCCUPANCY GROUP
/
' 2ND Floor Base fee00 ,
3rd Floor Plan Check fee / 6
Htd Basement State Surcharge fee ! ` co
Unhtd Basement Subtotal ?) a S o
Garage/Carport Pot Water Review fee
Decks 911/Rd Approach fee •--o—
Commercial TOTAL 9() - . --(0
Industrial Receipt # J L 3 c 1
Other ---------- Cash/Check# ` .� '- >
Total Valuation:. e r- Initials o �� -_/
.__.___ �
Or .� .' Date 9 _ 9 0 0
Estimated Cost:
If{within 200' of the Shoreline,
Distance to Bank or Ordinary I-Nigh 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 tight 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 enuy to the applicant's property or e shall be requested and shall occur during regular business hours.
L
Signature: o ` ?1-f Date: / ` 9 "c 78/2