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HomeMy WebLinkAboutBLD2001-00092 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 #: BLD01-00092 Received Date 02/12/2001 SITE ADDRESS: 564 LARSON LAKE RD Issue Date 03/8/2001 CHIMACUM, 98325 Expiration Date 03/8/2002 APPLICANT: TOM SVORNICH PHONE: (206)842-9288 CHERYL SVORNICH 11388 OLYMPIC TERRACE NE BAINBRIDGE ISLAND WA 98110 SUBDIVISION: MT TOWNSEND VISTA Block: Lot: 6 PARCEL NUMBER: 801105006 Section: 10 Township: 28 N Range: 01 W CONTRACTOR: OWNER PHONE: LOAN LENDER/ BOND HOLDER: PROJECT DESCRIPTION DETACHED GARAGE REQUIRED INSPECTIONS: [„er w (Shoreline Setbacks): ©< _-S/ Q Al. Or , ngs r [l .OI f [ ] Underground Plumbing/Underground Insu ton: [--] Shear Wall: 4 k /iM/►t� �� c d( [tV c amrng/Ilumbing: Old 3/(7� ( (F' .OTla;-Ce-7-re)gl [ ] Propane Tank/Lines: [ ] Insulation: — o is ? —/s--c� di [ ] eetroc : ®/C -/31/0 [1-' Final/Occupancy Approval: , et'L HEALTH DEPART ENT 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 INSPECTI Office Hours 9:00 a.m. -4:30 p.m. Inspector's Phone Hours 8:00 a.m. - 9:00 a.m. HOT LINE AVAILABLE 24 HOURS A DAY is\F_BLD_Permit_Bu ildng.rpt 10/29/19 BUILDING PERMIT APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD01-00092 Received Date: 2/12/2001 SITE ADDRESS: 564 LARSON LAKE RD CHIMACUM, 98325 APPLICANT: TOM SVORNICH PHONE: (206)842-9288 CHERYL SVORNICH 11388 OLYMPIC TERRACE NE BAINBRIDGE ISLAND WA 98110 SUBDIVISION: MT TOWNSEND VISTA Block: Lot: 6 PARCEL NUMBER: 801105006 Section: 10 Township: 28 N Range: 01 W CONTRACTOR: OWNER PHONE: ARCHITECT/ ENGINEER : PROJECT DESCRIPTION: DETACHED GARAGE TYPE OF WORK GAR SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 160 VALUATION 14,936.00 ADD'L: HEAT TYPE: EEE CODE EDITION: 1997 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: 608 SHORELINE: CONST TYPE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: PWELL PARCEL TAGS: YES NO BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA Exist: Exist: Wetland Erosion Prop: Prop: Seismic Streams Total: Total: Flood Way Floodplain F&W Landslide Routing Date: Shoreline Aquifer ___. _.�_._ 1 '''' /Z7 0 / `" Forest: Comm r I I I B' Type Amount Paid By: Date: �rReceipt: , . .7. .dli,At �:� �• ii ,' Permit $251.25 MAM 02/12/01 38266 Plan Check $75.38 MAM 02/12/01 38266 MAR O 2001 State Building Code $4.50 MAM 02/12/01 38266 JEFFERSON COUNTY Total: $331.13 DEPT. OF COMVNITY DEV,,ELQOPtvA.ENT' SIGNATURE: # .... G..trr. . I Jefferson County Department of Comnnunfty Develoun t (----1,:sON oo'el, 621 Sheridan Street.Port Tower WA 88360(3601378-4450 ;:e at 4S ,�o LM o pp_ i] icat0On hIN > 0 o a 0 Project Description: o o Building Type: t„ Project Type: Frame Type: ❑ Single Family m w New j53;Wood X Garage Attached/Detached u_ „D ❑ Addition ❑ Steel ❑ Modular Q ❑ Alteration/Remodel ❑ Concrete Li Commercial � ❑ Repair ❑ Masonry ❑ Multi-family/#of Units ir:LjuDli � 1 o ❑ Demolition ❑ Other: ❑ Industrial ❑ Other: Bedrooms: Bathrooms: Type of Sewage Disposal: Type of Heat: Choose one: Existing. Existing: ❑ Sewer ❑ Community System IK Electricity ❑ Oil Proposed: 4=5 Proposed: EX Individual System ❑ Woodstove ❑ Propane Total: Total: If not sewer,fill out the following: ❑ Heat Pump ❑ Conventional X Alternative ❑ Other Permit# SEP 00 OO l O L Water Supply: ❑ Private well ❑ Two Party Well❑ Public:Name of water system: Square Footage: For Office Use Only Main Floor h t Cd O ? 'S( UBC OCCUPANCY GROUP 2ND Floor Base fee 2.67' 2C. 3rd Floor Plan Check fee 75 . 3 O Htd Basement State Surcharge fee Y r S D Unhtd Basement U n k Subtotal 33 /• /3 Garage/Carport 64t. 5,b. b Ogo Pot Water Review fee Decks 911/Rd Approach fee Commercial TOTAL 33 /- /3 Industrial Receipt# gip2 :: ( ' Other Cash/Check# 4233 y Total Valuation: —r---• Initials ?/1/ / y193 19 Date �/ Z (/ Or 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.. ' `rrs• b•vcst.x-e-iL-.. Date: ?- i 3. -0 1 II:l-TOME\PLNC�NTR\INFOBLDG\FORMS\BLD ermitA licationl/2000 P PP Jefferson County Department of Community Development M( -D l — S ���5onr co _ 621 Sheridan Street,Port Townsend WA 98368 (360) 379-4450 4 $ -11 V versal Plot Plan JEFFERSON COUNTY DEPT OF rr,MM',tirT nr' , CC-0 ,�„ Fill in the following -blanks as completely as possible: Project Description: NEW 1-NouSE 4 e.nRI.gs.GnE. 9 Digit Parcel Identification Number(from your tax statement): Sol toy bolo Site Address 911#: 56 t} Road Name: LA(Z6O N 14A04.E ROAD Zip Code: a 8 3 z£ Legal Description Subdivision Name: MT. t o w2,45R N ,.Block: Lot(s): (o Section: a Township: 28 N Range: Q w Parcel Size (acres or square footage): 5 At.>xerr.25 Property Owner: Phone: 1 o M 5vo tZN i c.t-1. (2 ) S'-k z• ciZSP, Mailing Address: 1 l 39� OL-VAA t- T . ME. 13NINI3Rt't E- I. . As 41Q 1 tO Applicant/Occupant: Phone: (if different from owner) 5p,M C Mailing Address: Authorized Rep: Phone: Mailing Address: General Contractor Or Manufactured Home Installer: ow',fa Phone: Mailing Address: Contractor's State License Number: Expiration Date: Septic Designer: Phone: `5a_N E / N Ct \NEL , ($ (.3400) 325- 55 I Mailing Address: --Po fox t22.t 1-?o E-F Wfr `183-2,at Architect:/Engineer: Phone: UWN .' Mailing Address: Loan Lender/General Phone: Contractor's Bond Holder: d w N E Mailing Address: FOR OFFICE USE ONLY Fire District: Planning Area: School District: Zone: 1/00 H:\home\pincntr\forms\universal plot plan v l ft :J . A • . I LZ ' tf, ,_ , _,___, +- +_--,_ .... . . , ,,, , _ . . , , , 1 . . : : .... _,.. , , ., _„_, .t.,, --ts-t - ,, ; , . 1 .1,..„., , f wr I . y • • • I . .. a .- i �. • , t VMM) n WSeAS 1e"^62 a m 0....... fl -§ E3 i m I ....i. >0 Z VJ A 01, ` "_� . O .04 > ' xI ALl > 1 ..,..iiiliW I I . t M. sal Gait . 0 1 Y / , `J �0 - -� cam T 1. !n 7 m H RGI zo $ —{ O O C m� Lpp m N LAKE ROAD C::)