HomeMy WebLinkAboutBLD2002-00535 • 4110
BUILDING PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD02-00535 Received Date 09/12/2002
SITE ADDRESS: 94 SEA BREEZE LN Issue Date 09/13/2002
PORT LUDLOW, 98365
APPLICANT: TERRENCE L RAWLINGS PHONE: (360)437-9321
CAROLINE R RAWLINGS
94 SEABREEZE LN
PORT LUDLOW WA 98365
SUBDIVISION: TEAL LAKE VILLAGE Block: Lot: 27
PARCEL NUMBER: 998700027 Section: 21 Township: 28 N Range: 01 E
CONTRACTOR: WHITEY JOHNSON GENERAL CONTR PHONE: (360)779-9884
PO BOX 1110
SUQUAMISH WA 98392
Contractor's License: WHITEJG159DN Expires: 03/15/2003
LOAN LENDER/
BOND HOLDER:
PROJECT DESCRIPTION REMODEL UTILITY ROOM
REQUIRED INSPECTIONS:
[ ] SETBACKS / Footings:
[ ] Foundation:
[ ] Underground Plumbing/Underground Insulation:
[ ] Shear Wall:
[ ] Framing/Plumbing:
[ ] Propane Tank/Lines:
( ] Insulation:
[ ] Sheetrock: 4/, zc7,4/
[ ] Septic System Final Approval:
[ ] Zoning Final Approval:
[ ] Final/Occupancy Approval: 7442 /ilvQ / OHEALTH DEPARTME .AP'OVAL REQUIRED P OR O 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
BUILDING PERMIT APPLI ION B Review 00rape35
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00535 Received Date: 9/12/2002
SITE ADDRESS: 94 SEA BREEZE LN
PORT LUDLOW, 98365
OWNER: TERRENCE L RAWLINGS PHONE: (360)437-9321
CAROLINE R RAWLINGS
94 SEABREEZE LN
PORT LUDLOW WA 98365
SUBDIVISION: TEAL LAKE VILLAGE Block: Lot: 27
PARCEL NUMBER: 998700027 Section: 21 Township: 28 N Range: 01 E
CONTRACTOR: WHITEY JOHNSON GENERAL CONTR PHONE: (360)779-9884
PO BOX 1110
SUQUAMISH WA 98392
Contractor's License WHITEJG159DN Expires 3/15/2003
REPRESENTATIVE: WHITEY JOHNSON PHONE: (360) 779-9884
PO BOX 1110
SUQUAMISH WA 98392
PROJECT DESCRIPTIOI REMODEL UTILITY ROOM
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP ALT MAIN:
VALUATION 2,500.00 ADD'L: HEAT TYPE: HTP
CODE EDITION: 1997 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY:
CONST TYPE: OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK: 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 Floodplain
Routine Date: F&W Landslide
—\�j— Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid Bv: Date: Receipt: D�t
Permit $83.25 MAM 09/12/02 50959 Pp�vO
Plan Check $54.11 MAM 09/12/02 50959
State Building Code $4.50 MAM 09/12/02 50959 SEP 1 3 2002
Total: $141.86 Jefferson County Planning
& Building Department
SON co Jeffers t j Department of Community Dov opt tt
w 621 Sheridan Street,Port Townsend WA 88368(360]378-4450\ ..... ".,___,....t...,..,, , ,) Perin u Ap
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Project Description:
Building Type: Project Type:
z. \\ Prime
e:
�Vn le Family ❑ New . .� qV_ fg
,,..,Garage__ Attached/Detached ❑ Addition „t 4.iteel
,
Modular / Alteration Remo S0 i oncrete
Commercial ❑ Repair `` .) ❑ Masonry
I Multi-family/#of Units ❑ Demolition ,s49Q ❑ Other:
Industrial t-cl
I Other: , ``
Bathrooms: Bedrooms: Type of Sewage Disposal: Type of Heat:
Choose one:
Existing: - Existing: C /7 Sewer Community System ❑ Electricity ❑ Oil
Proposed: C..F Proposed: 0 ❑ Individual System ❑ Woodstove ❑ Propane
Total: C."s- Total: 0
If not sewer,fill out the following: /Heat Pump
❑ Conventional ❑ Alternative ❑ Other
Permit# SEP
Water Supply:
Private well 0 Two Party Well L Public:Name of water system:
i Square Footage: For Office Use Only
Main Floor Consistency Review
2ND Floor Base fee 2 r ,'a`�
3rd Floor Plan Check fee S Li o \ 1
Htd Basement State Surcharge fee tA,S- O
L'nhtd Basement Subtotal r \\ u 7C\p
Garage/Carport Pot Water Review fee
Decks 911/Rd Approach fee
Commercial TOTAL \ LA , (,,
Industrial Receipt# j---d ?,tS t"%
Other Cash/Check# /a a '7
Total Valuation: Initials RA C-
Or Date 9 — !<, -Q A
ot1
Estimated Cos t\ 7f -- )
1 If within 200' of the Shoreline,
Distance to Bank or Ordinary High Water Mark ft. Bank Height ft.
i
liy 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 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 app ca is property or structure shall be requested and shall occur during regular business hours.
l o
Signature: Date: 1//r
OVER ►
l I:EIOME\PLNCNTR\INFO LDG\FORMS\BLDpermitApplication 11-8-01
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iviONC, • ,� v ]�V
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, °��, JEFFERSON COUNTY 0-7.),..7+~��., 446,`� DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street• Port Townsend •Washington 98368 � CO
.�{ �
'4%NG� 360/379-4450.800/831-2678 .360/379-4451 Fax ``®
www.co.jefferson.wa.us/commdevelopment 0
Master Land Use Permit Application Form ����
PROPERTY INFORMATION •
Tax Parcel Number: al Efi El 0 El 0
Subdivision Name: 7'-q -L �� z- \/t L_L,`1 „-►4. Lot Number: 7
Property Size: i I C., 4. G, 1 (acres/square feet) Existing Use of Property: `_i t to t..-i,_ F46 t i L✓ e
Site Address and/or Directions to Property: '141 5 erN F30,aa-?.E L.A..-) F'C t2r' Li n4 LOA '6-.:E7;--
APPLICANT INFORMATION
Property Owner(s)of Record 0 rJCG 4 plkp .•t&)L vc� cw:...t A.)C.- Telephone: (,/, 1--5 7 4.57,I
Address: 141- }p,c- `e LA-
City: 1=',0F,.7' LAAni.„-rr,.c.> State: GUtt Zip Code: ge ifs_'? Email Address
Name of Authorized Agent(if applicable): 1,04iT'�- -' V.03.4- <• ,j„> Telephone: =le i)7,741 cia84.
Address: 7O tom,k I 1 10
City: C- ,c)� „ , ci ,f„f State: U)* Zip Code: el S S 2 Email Address
I reby designate a-6-4-i-t---e-J,� to act as my agent in matters related to this application for permit(s).
/11 h2-
(APPLICANT SIGNATURE) (DATE)
DESCRIPTION OF PROPOSED USE OR ACTIVITY(include separate sheets as necessary)
A .r -r_.t►..,> -� IN.F> 'r/tee.)A•-c.I-t Lu I 4 , , 1-a-E-C) � C- ' 7-'c
[THIS SECTION FOR OFFICE USE ONLY]
Refer to the specific sections of the UDC referenced below for more information and further requirements. An asterisk(*) indicates
that a supplemental application or questionnaire may be required.
Type I Permits Refer to:
• Septic Permit/Evaluation of Existing System(EES) UDC Section 6.4.1 and Chapter 8.15 JCC
ilding/Demolition Permit UDC Section 3.2.1 and Table 3-1
Allowed "Yes" Use Consistency Analysis UDC Section 3.2.1 and Table 3-1
O Home Business Table 3-1 and UDC Section 4.20
O Stormwater Management* UDC Section 6.7
O Road Access* UDC Section 6.8
O Boundary Line Adjustment* UDC Section 7.2
O Minor PRRD Amendments UDC Section 3.6.13.15
O Sign Permit* UDC Section 6.15
O Site Plan Approval Advance Determination (SPAAD) UDC Section 8.7
O Shoreline Master Program Exemption/Permit Revisions UDC Section 5
O Temporary Use(based on use may be Type II or Type III)* UDC Sections 4.38 and 4.39
[OVER]
MASTER LAND USE PERMIT.DOC REV.10/05/2001
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