HomeMy WebLinkAboutBLD2001-00487 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 #: BLD01-00487 Received Date 08/24/2001
SITE ADDRESS: 261 SENTINAL FIRS RD Issue Date 09/13/2001
PORT HADLOCK, 98339 Expiration Date 09/13/2002
APPLICANT: ROY MERGEL PHONE: (360)437-2768
MARY L MERGEL
261 SENTINAL FIRS RD
PORT HADLOCK WA 98339-9765
SUBDIVISION: Block: Lot: T 48A
PARCEL NUMBER: 921193033 Section: Township: N Range: 11 W
CONTRACTOR: OWNER PHONE:
LOAN LENDER/
BOND HOLDER:
PROJECT DESCRIPTION WELL HOUSE
REQUIRED INSPECTIONS:
[ ] Setbacks (Shoreline Setbacks):
[ ] Footings:
[ ] Foundation:
[ ] Underground Plumbing/Underground Insulation:
[ ] Shear Wall:
[ ] Framing/Plumbing:
[ ] Propane Tank/Lines:
[ ] Insulation:
[ ] Sheetrock:
[ ] Final/Occupancy Approval:
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.
HOT LINE AVAILABLE 24 HOURS A DAY
is\F_BLD_Permit_Buildng.rpt 10/29/19
BUILDING PERMIT APPLICATION ReAOw Ope: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD01-00487 Received Date: 8/24/2001
SITE ADDRESS: 261 SENTINAL FIRS RD
PORT HADLOCK, 98339
OWNER: ROY MERGEL PHONE: (360)437-2768
MARY L MERGEL
261 SENTINAL FIRS RD
PORT HADLOCK WA 98339-9765
SUBDIVISION: Block: Lot: T 48A
PARCEL NUMBER: 921193033 Section: Township: Range: 11 W
CONTRACTOR: OWNER PHONE:
REPRESENTATIVE(S):
PROJECT DESCRIPTIO WELL HOUSE
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 192
VALUATION 1,920.00 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:
WATER SYSTEM: 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: 1 ?1/4..
Shoreline Aquifer
l --- Forest: Commercial Rural
*1 Proximity Plat Conditions
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $69.25 MAM 08/24/01 30257
Plan Check $20.78 MAM 08/24/01 30257 APPROVE
State Building Code $4.50 MAM 08/24/01 30257
Total: $94.53 SEP 1 2 2001
`JEFFER •N COUNTY`
DEPT.OF C• r N D ZENT
SIGNATUU • - ,�'--->
fp°,1" c°<, JEFFERSON COUNTY [ ( [ E ,--�
DEPARTMENT OF COMMUNITY DEVELOPMENT
Qq 621 Sheridan Street • Port Townsend • Washington 98368 AUGZ
s$jN(3l`� 360/379-4450 • 800/831-2678 • 360/379-4451 Fax
JEFFERSON COUNTY
BUILDING PERMIT APPLICATIO EPT. OF COMMUNITY DEVELOPMENT
Project Description:
Building Type: Project Type: Frame Type:
❑ Single Family New l Wood
• Garage Attached/Detached ❑ Addition ❑ Steel
• Modular ❑ Alteration/Remodel ❑ Concrete
• Commercial Repair E Masonry
❑ Multi-family/#of Units ❑ Demolition ❑ Other:
❑ Industrial
N Other: L✓(LL c t',S C
Bedrooms: Bathrooms: Type of Sewage Disposal: Type of Heat:
Choose one:
Existing: Existing: ❑ Sewer 0 Community System ❑ Electricity ❑ Oil
Proposed: Proposed: 0 Individual System ❑ Woodstove ❑ Propane
Total: Total: If not sewer,fill out the following: ❑ Heat Pump
❑ Conventional ❑ Alternative ❑ Other
Permit# SEP
Water Supply:
❑ Private well ❑ Two P. Well❑ Public:Name of water system:
Square Footage: For Office Use Only
Main Floor �l Z0 UBC OCCUPANCY GROUP
2ND Floor Base fee b9t
3rd Floor Plan Check fee aC,/
Htd Basement State Surcharge fee q ' --5iv'
Unhtd Basement Subtotal '/ 4 `' 5_3
Garage/Carport Pot Water Review fee
Decks 911/Rd Approach fee
Commercial TOTAL ' ✓5 3
Industrial Receipt# 3 C 5
Other Cash/Check# 1 L/I
Total Valuation: Initials S
Or Date
/9" '� I
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: Date: —Z /-67
H:HOME\PLNCNIR\ 'OBLDG\FO iMS\BLDpermitApplicationl/2000
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