HomeMy WebLinkAboutBLD2002-00697 •UILDING PERMIT APPLICAA N ML ReviewTy 601
Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00697 Received Date: 11/25/2002
SITE ADDRESS: 92 BLUE DOG RD
PORT TOWNSEND, 98368
OWNER: PAUL L THOMAS PHONE: (206)246-3020
11612 25TH AVE S
SEATTLE WA 98168-1206
SUBDIVISION: BLUE RIDGE PEAK SHORT PLAT Block: Lot: 3
PARCEL NUMBER: 001292020 Section: 29 Township: 30 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: JESSE THOMAS PHONE: (360)385-2859
2315 S DISCOVERY RD
PORT TOWNSEND WA 98368
PROJECT DESCRIPTION SHOP /STORAGE
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 280
VALUATION 6,600.00 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
Routing Date: F&W Landslide
V ZIP (0 Z Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $139.25 MAM 11/25/02 51425
Plan Check $90.51 MAM 11/25/02 51425
State Building Code $4.50 MAM 11/25/02 51425
Total: $234.26
o ` _ V E ( n , , I Count artmont of Community Development
��4 ON °° an Street,Port Townson:WA 08368[3601378-4450
`" r f`i t '�" ,1 t� o �'
-4 p FFE'ON COUNTY o O O Oo
`QS,���2 DEPT. OF COMMUNITY
DEVELOPMENT
Project Description:
Building Type: Project Type: Frame Type:
❑ Single Family � New �' Wood
❑ Garage Attached/Detached ❑ Addition ❑ Steel
❑ Modular ❑ Alteration/Remodel ❑ Concrete
❑ Commercial ❑ Repair ❑ Masonry
❑ Multi-family/#of Units ❑ Demolition ❑ Other:
❑ Industrial
XOther: __ _ 7 aligAr(+.`. _
Bathrooms: Bedrooms: Type of Sewage Disposal: Type of Heat:
Choose one:
Existing: Existing: ❑ Sewer ❑ Community System ❑ Electricity ❑ Oil
Proposed: Proposed: ❑ Individual System ❑ Woodstove ❑ Propane
Total: Total: If not sewer,fill out the following: ❑ Heat Pump
❑ Conventional ❑ Alternative t Other NO/0
Permit# SEP
Water Supply:
1 ❑ Private well ❑ Two Par Wellp--Piame_ofwater system:
Square Footage: br Office Use Only
Main Floor a.QO toc /Q q, b 0 nsistency Review 47.00
2ND Floor Base fee 13 9. as
3rd Floor Plan Check fee—65% 0. 5
Htd Basement State Surcharge fee LA S 0
Unhtd Basement Subtotal 0 i. L
Garage/Carport Pot Water Review fee
rPrr
Decks 911/Rd Approach fee 1� .e.
Commercial TOTAL /�r r O�b
Industrial Receipt# 6 ! £�r��O-�5
Other Cash/Check# O
Total Valuation: Initials
Or 97 Date << 2S 0 2_
Estimated Cost: ' '5 t 41.•&9.0 -.
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.
1 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 applicant's pro erty or structure shall be requested and shall occur during regular business hours.
Signature: ,5(2
Date: I (/!S�1 2._
OVER
H:HOME\PLNCNTR\INFOBLDG\FORMS\BLDpermitApplication 11-8-01
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