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HomeMy WebLinkAboutBLD2003-00037 410 BUILDING PERMIT et: Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD03-00037 Received Date 01/2 2003 `, SITE ADDRESS: 313723 HWY 101 Issue Date 0 /1 i 003 BRINNON, 98320 APPLICANT: CYNTHIA A CUZICK PHON : (360 796-0154 PO BOX 1700 HOODSPORT WA 98548-1700 SUBDIVISION: BI ck: ot: PARCEL NUMBER: 502311002 Section: 31 To • • 25 N Ra ge: 0. W CONTRACTOR: DOGWOOD CONSTRUCTION INC PHONE (360)898-6102 E 90 TOWER LN UNION WA 98592 Contractor's License: DOGWOC1990R4 Ex es: 12/ 4/2 3 LOAN LENDER/ BOND HOLDER: J PROJECT DESCRIPTION REMODEL SINGLE F ILY R SID CE KtUUIKtU INSNt(:I IONS: [ ] SETBACKS / Footings: [ ] Foundation: [ ] Underground Plumbing/Undergro d Insulation: [ ] Shear Wall: [ ] Framing/Plumbing: [ ] Propane Tank/Lines: [ ] Insulation: [ ] Sheetrock: [ ] Septic System Final Approval: [ ] . Zoning Final Approval: [ ] 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 OUILDING PERMIT APPLICAJN MRLA03 000 30 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD03-00037 Received Date: 1/21/2003 SITE ADDRESS: 313723 HWY 101 BRINNON, 98320 OWNER: CYNTHIA A CUZICK PHONE: (360)796-0154 PO BOX 1700 HOODSPORT WA 98548-1700 SUBDIVISION: Block: Lot: PARCEL NUMBER: 502311002 Section: 31 Township: 25 N Range: 02 W CONTRACTOR: DOGWOOD CONSTRUCTION INC PHONE: (360)898-6102 E 90 TOWER LN UNION WA 98592 Contractor's License DOGWOC1990R4 Expires 12/24/2003 REPRESENTATIVE: WAYNE DEVANEY PHONE: (360)796-0154 PO BOX 1700 HOODSPORT WA 98548 PROJECT DESCRIPTIOr REMODEL SINGLE FAMILY RESIDENCE TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP ALT MAIN: VALUATION 114,400.00 ADD'L: HEAT TYPE: EEE CODE EDITION: 1997 HEAT BASE: HEAT TYPE: OCCUPANCY: R-3 UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: 5N GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: 10 BANK HEIGHT: SEWAGE DISPOSAL: OSS WATER SYSTEM: PWELL PARCEL TAGS: YES NO BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA Exist: 1 Exist: 1 Wetland Erosion Prop: Prop: Seismic Streams Total: 1 Total: 1 Flood Way Floodplain Routing Date: /_&ga F&W Landslide ri Shoreline Aquifer Forest: Commercial Type Amount Paid By: Date: Receipt: Approved/ e Permit $1,077.75 MAM 01/21/03 52914 FEB 1 1 2003 Plan Check $700.54 MAM 01/21/03 52914 State Building Code $4.50 MAM 01/21/03 52914 Jefferson County Planning Potable Water Application $50.00 MAM 01/21/03 52914 & Building Department Total: $1,832.79 111, Tr aaak ,.-- • . . _ \\c. \INi•T-4/A_ eutz__tcr_ a 4 Zi, 601> r o)J �i r Q 7:i \ '''''' ' \'' '..\ _ h S, �� �4. r t ill .Cop{ . 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' , 1. 1711 - 1 •mmim 'miiiiiiii . ........(::1\1 $:':.-__:-.2 0 1===:y V Nt fi V.,- —54 ' 1 ;,,‘'; ,'fl 1r\ 0... `z • ,t ' I,..r.- L --- ; %.. ----- • t-4 • 4110 Stormwater Calculations IMPERVIOUS SURFACE NEW EXISTING Structures (all roof area) sq/ft Structures(all roof area) //( sq/ft Driveway sq/ft Driveway /6 sq/ft Sidewalks sq/ft Sidewalks G7 sq/ft Patios sq/ft Patios � sq/ft Covered/Solid Decks sq/ft Covered/Solid Decks sq/ft Other sq/ft Other sq/ft Total New sq/ft Total Existing ' ' 7 sq/ft TOTAL NEW TOTAL EXIS IT NGY f zi sq/ft *This amount will be used to check total lot coverage Please also indicate the amount of land disturbing activity, in addition to the creation of impervious surface, that will take place: LAND DISTURBING ACTIVITY 0 ..-r Drainfield area cleared sq/ft Well, Structures, Utilities, etc. sq/ft Driveway sq/ft Other sq/ft Total Land Disturbance sq/ft JAN 212003 JEFFERSON COUNTY DCD II/ Jefferson C artment of Community Development ��� � colv � 621 Simian Street,Port Townsend WA 88368[360]378-4450 F7 r` �`_- IV O 4S ���,, ,. Per M 6 -ff- A App .. 0 cdB1©n N . . '" cA,1) Project Description. ." ' Building Type: Project Type: Frame Type: Single Family ❑ New Wood ❑ Garage Attached/Detached 1 t ', 2tnn ❑ Addition ❑ Steel ❑ Modular JA A Alteration/Remodel ❑ Concrete ❑ Commercial ,,,rri OCp ❑ Repair ❑ Masonry ❑ Multi-family/#of Units p'tW " a COU ❑ Demolition ❑ Other: ❑ Industrial 11E5t 6"3' ❑ Other: Bathrooms: Bedrooms: Type of Sewage Disposal: Type of Heat: Choose one: Existing: i Existing: 1 ❑ Sewer ❑ Community System X Electricity ❑ Oil Proposed: 0 Proposed: d X.Individual System ❑ Woodstove ❑ Propane Total: , Total: ( If not sewer,fill out the following: ❑ Heat Pump ❑ Conventional ❑ Alternative El Other Permit# SEP 8 el ` —11 T/ Water Supply: NI' Private well ❑ Two Party Well❑ Public:Name of water system: Square Footage: For Office Use Only Main Floor Consistency Review 47.00 2ND Floor I 0 Base fee 11_01 '-) •-7 S! 3rd Floor Plan Check fee—65% —7e O 5 4/ Htd Basement State Surcharge fee e� (., Unhtd Basement Subtotal I ?r• CI_ 1 1 Garage/Carport Pot Water Review fee 21--06 Decks 911/Rd Approach fee Commercial TOTAL \ i l 0 , l Industrial _____' Receipt# `j c9%, /'/p Other Cash/Check# /0/ / Total Valuati \ Initials l" v Or Date / —, -1 —{t3 0,40 Estimated C �/ - . �, If within 200' o reline Distance to Bank or Ordinary High Water Mark 1 Li 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 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,gtructure shall be requested and shall occur during regular business hours. r Signature: -vKry/- 1, vim,.a Date: /e /�'/i% ? OVER H:HOME\PLNCN'1R\INFOBLDG\FORMS\BLDpermitApplication 11-8-01 7,?..501NT �, 0in 03 " Q rzi V JEFFEflit% ON COUNTY ti DEPARTMENT OF COMMUNITY DEVELOPMENT - 4 )' . . 621 Sheridan Street• Port Townsend •Washington 98368 1 S87NGO 360/379-4450.800/831-2678 .360/379-4451 Fax www.co.jefferson.wa.us/commdevelopment Master Land Use Permit Application Form IPROPERTY INFORMATION Tax Parcel Number: © El Q ® © El CI CI i . Subdivision Name: Lot Number: Property Size: /6,DOO iF (acres/square feet) Existing Use of Property: Site Address and/or Directions to Property: 3/3 723 i r y fa j yj,„v, ' - ' / Sv1/'zv 0F /4"-ereTe APPLICANT& OWNER(INFORMATION Applicant(if applicable): f„�, wp proc,&Y Telephone: 64',/ -775 0, ''y Address: PO,Yox /70U City: Nao pijteiee r— State: 4/,/,t Zip Code: ?fry if Email Address Applicant's Signature:,, —., 'Z Property Owner(s)of Record: C'IiV r N/ A C U2/Cii Telephone: .- 0- 7 9(:- 0 /S y Address: P. (7. 6 U f( 17( , City: 1--/-"'(0 WIC /'7— State: (k-'/ Zip Code: Email Address I acknowledge that the ap licant above is applying for a building permit on my property. Owner's Signature: ,7 { 7`� L I hereby designate to act as my agent in matters relating to this application for permit(s). (PROPERTY OWNER SIGNATURE) (DATE) DESCRIPTION OF PROPOSED USE OR ACTIVITY(include separate sheets as necessary) i ` iE. .1 Ci I y 6{ 1.- I I , � 'P'97""' -- i 9L--- [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: Y❑ Septic Permit/Evaluation of Existing System(EES) UDC Section 6.4.1 and Chapter 8.15 JCC Building/Demolition Permit UDC Section 3.2.1 and Table 3-1 ii Allowed"Yes" Use Consistency Analysis UDC Section 3.2.1 and Table 3-1 ❑ Home Business Table 3-1 and UDC Section 4.20 ❑ Stormwater Management* UDC Section 6.7 ❑ Road Access* UDC Section 6.8 ❑ Boundary Line Adjustment* UDC Section 7.2 ❑ Minor PRRD Amendments UDC Section 3.6.13.15 ❑ Sign Permit* UDC Section 6.15 ❑ Site Plan Approval Advance Determination(SPAAD) UDC Section 8.7 ❑ Shoreline Master Program Exemption/Permit Revisions UDC Section 5 0 Temporary Use (based on use may be Type II or Type III)' UDC Sections 4.38 and 4.39 (OVER) a a 11111 Type II Permits Refer to: • T . ❑ Discretionary"D"or Unnamed Use Classification UDC Sections 3.2.1,3.2.2 and Table 3-1 ❑ Cottage Industry UDC Section 7.3 and Table 3-1 ❑ Short Plat, Preliminary and Final* UDC Section 7.3 ❑ , Binding Site Plan* UDC Section 7.5 ❑ Conditional (Administrative)"C(a)"Use UDC Table 3-1 and S ction 8.8 ❑ Conditional (Discretionary)"C(d)"Use UDC Table 3-1 and S ction 8.8(Discretionary Permit Review Process Dete fined by Administrator) ❑ Variance, Minor* UDC Section 8.9 ❑ Wireless Telecommunication Ordinance 06-0712-9 (UDC Appendix C) ❑ Shoreline Substantial Development(Primary Use) UDC Section 5 ❑ Forest Practices Act/Release of Six-Year Moratorium for Single- UDC Section 4.16.5( ) Family Residence ❑ Appeal UDC Section 8.4.2 SEPA 8.10.12(b) Type Ill Permits ❑ Conditional"C" Use UDC Section 8.8 ❑ Long Plat, Preliminary* UDC Section 7.4 ❑ Planned Rural Residential Development Preliminary Approval UDC Section 3.6.13(must be in conjunction with an (PRRD)and Major Amendments* underlying land division application) ❑ Plat Vacation/Alteration UDC Section 7.1.3(d) ❑ Variance, Major* UDC Section 8.9 ❑ Reasonable Economic Use Variance* UDC Section 3.6.4(h) ❑ Wireless Telecommunication Ordinance 06-0712-99 UDC Appendix C ❑ Shoreline Management Substantial Development, Secondary Use* UDC Section 5 ❑ Shoreline Management Conditional Use* UDC Section 5 ❑ Shoreline Management Variance* UDC Section 5 ❑ Appeal UDC Section 8.4.3 SEPA 8.10.12 (c) Type IV Permits ❑ Long Plat, Final UDC Section 7.4 ❑ PRRD, Final UDC Section 3.6.13 4; `8,,) ey• , Type V Permits , ❑ Special Use(Essential Public Facilities) UDC Section 3.3.5 ° .'V ❑ Jefferson County Comprehensive Plan/UDC/Land Use District Map UDC Section 9 �u"� o Amendment* ❑ Jefferson County Shoreline Master Program Amendment* UDC Section 5 , �,\j ❑ Appeal of SEPA UDC Section 8.10.12(d) Other Local,State or Federal Permits ` ❑ Please identify any other local, state or federal permits required for this proposal, if known: ACKNOWLEDGEMENTS [PLEASE NOTE THAT TWO SIGNATURES ARE REQUIRED] By signing the application form, the applicant/owner attests that the information provided herein is true and correct to the best of their knowledge. I also certify that this application is being made with the full knowledge and consent of all owners of the affected property. 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 its employees, representatives or agents for the sole purpose of application review and any required later inspections. This right of entry shall expire when the County (through the Administrator or the Administrator's representatives)concludes the application has complied with all applicable laws and regulations.Access and right of entry to the applicant's property shall be requested and shall occur only during regular business hours. 1. ! ..s.> (J‘gi. .;er /t%/' ?L. (PROPERTY OWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DA ) The action or actions Applicant will undertake as a result of the issuance of this permit may negati ly impact upon one or more threatened or endangered species and could lead to a potential"take"of an endangered species as those term are defined in the federal law known as the "Endangered Species Act" or "ESA." Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued will not violate the ESA. Any individual, group or agency can Ile a lawsuit on behalf of an endangered species regarding your action(s)even if you are in compliance with the Jefferson County developme t code The Applicant acknowledges that he, she or it holds individual and non-transferable responsibilit for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. 2. .may-- Ge•- ....---`., " te745-1/4 2_ (PROPERTY OWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE) .,. , . , i -, i I / i ' , i ,,,.• 7 I i yo",s,.i ) ., i ... ,. . , . . . , , t 1 , t . , . . . , . •tti;,-,. . , ,.„ .t, . .., I i....... 3 1/ 0...„)., „ _ . . , , . . . . . . . . ...,,. . . . . , ,._ r... I . — ...,