HomeMy WebLinkAboutBLD2001-00025 " BUILDING PERMIT APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD01-00025 Received Date: 1/12/2001
SITE ADDRESS: 685 LUDLOW BAY RD
PORT LUDLOW, 98365
APPLICANT: ED JANKOWSKI PHONE: (360)437-1351
JOANNE JANKOWSKI
41869 N 111TH PL
SCOTTSDALE AZ 85202
SUBDIVISION: LUDLOW BEACH TRS 2 Block: Lot: 6
PARCEL NUMBER: 969000006 Section: 16 Township: 28 N Range: 01 E
CONTRACTOR: OWNER PHONE:
ARCHITECT/
ENGINEER :
PROJECT DESCRIPTION: INTEREOR REMODEL (NO CHANGE IN FOOTPRINT)
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP ALT MAIN: 2,180
VALUATION 12,000.00 ADD'L: 1,196 HEAT TYPE: HTP
CODE EDITION: 1997 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: GARAGE: 811 SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: OSS
WATER SYSTEM: LUDLOW PARCEL TAGS: YES NO
BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA
Exist: 3 Exist: 3 Wetland Erosion
Prop: Prop: Seismic Streams
Total: 3 Total: 3 Flood Way Floodplain
F&W Landslide
Routing Date: �//I�( / Shoreline Aquifer
I Forest: Commercial Rural
—Proximity - Plat Uonditions
Type Amount Paid By: Date: Receipt: Approvedi ate
Permit $209.25 MAM 01/12/01 35697
Plan Check $62.78 MAM 01/12/01 35697
State Building Code $4.50 MAM 01/12/01 35697
Total: $276.53
��s° ' 6.' Sheridan Jefferson County Department of Community Development
.• eridan Street,Port Townsend WA 88368[360)378 4450
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Project Description: plifig, o2. -N--�'µ,eh+-.'r " ,i- .la ruin-vitt,o r ri
Building Type: Project Type: Frame Type:
K Single Family - New X,Wood
Garage Attached/Detached 0 Addition 0 Steel
Modular Alteration/Remodel 07 Concrete
Commercial 0 Repair 0 Masonry
Multi-family/#of Units I Demolition I Other:
I Industrial
Other:
Bedrooms: Bathrooms: Type of Sewage Disposal: Type of Heat:
Choose one:
Existing: 3 Existing: 3 Sewer Community System ❑ Electricity I Oil
Proposed: Proposed: O yS(Individual System ❑ Woodstove 0 Propane
Total: 3 Total: 3 If not sewer,fill out the following: ,(Heat Pump
I Conventional n Alternative ❑ Other
Permit# SEP
Water Supply:
Private well ❑ Two Party Well I Public:Name of water system:
Square Footage: For Office Use Only
Main Floor L/k UBC OCCUPANCY GROUP
2ND Floor //f‘ Base fee 201., Z S
3rd Floor Plan Check fee (j Q - 7 F
Htd Basement State Surcharge fee l - So
Unhtd Basement Subtotal 27(p, S 3
Garage/Carport g/l Pot Water Review fee —C)
Decks 911/Rd Approach fee
Commercial TOTAL b -S 3
Industrial Receipt # 2 5--6 1
Other • Cash/Check # 3 Er-* 3
Total Valuation: _ h O0 Initials (`
Or Lf V Date l —./ .).—_c)/
Estimated Cost:
If within 200' of the Shoreline,
QDistance 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 attorney'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 pr, 'de cess and right of-.• r.Jefferson County and it's employees,representatives or agents for the purpose of application review and any required later inspections..
Access and right• en •the applicant's p.p- , or /shall be request and shall occur during regular business hours.
Signature ' Ail --1 ("% Date: ///— 4(,/
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