HomeMy WebLinkAboutBLD2003-00092 •
BUILDING PERMIT S
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT#: BLD03-00092 Received Date 02/18/2003
SITE ADDRESS: 171 E UNCAS RD Issue Date 02/20/2003
PORT TOWNSEND, 98368
APPLICANT: DOUGLAS J BREITHAUPT PHONE: (360)379-0531
VICKI S BREITHAUPT
171 E UNCAS RD
PORT TOWNSEND WA 98368-9743
SUBDIVISION: LUNDSTROM'S ADDITION Block: Lot:
PARCEL NUMBER: 969600501 Section: 25 Township: 29 N Range: 02 W
CONTRACTOR: OWNER/BUILDER PHONE:
LOAN LENDER/
BOND HOLDER:
PROJECT DESCRIPTION ROOF REPAIR
REQUIRED INSPECTIONS:
[ ] SETBACKS / Footings:
[ ] Foundation:
[ ] Underground Plumbing/Underground Insulation:
[ ] Shear Wall:
[ ] Framing/Plumbing:
[ ] Propane Tank/Lines:
[ ] Insulation:
[ ] Sheetrock:
[ ] Septic System Final Approval:
[ ] Zoning Final Approval:
[ yo Final/Occupancy Approval: C- /a?,--D,/
HEAL 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
UILDING PERMIT APPLICATION B RD Review
Typ92
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00092 Received Date: 2/18/2003
SITE ADDRESS: 171 E UNCAS RD
PORT TOWNSEND, 98368
OWNER: DOUGLAS J BREITHAUPT PHONE: (360)379-0531
VICKI S BREITHAUPT
171 E UNCAS RD
PORT TOWNSEND WA 98368-9743
SUBDIVISION: LUNDSTROM'S ADDITION Block: Lot:
PARCEL NUMBER: 969600501 Section: 25 Township: 29 N Range: 02 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOt ROOF REPAIR
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP REP MAIN:
VALUATION 6,000.00 ADD'L: HEAT TYPE: UH
CODE EDITION: 1997 HEAT BASE: HEAT TYPE:
OCCUPANCY:
OCCUPANCY: UNHEATED: #OF STORIES:
CONST TYPE: OTHER: SHORELINE:
CONST TYPE: GARAGE: 768 SETBACK:
DECK: 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: mak F&W Landslide
Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid Bv: Date: Receipt: Approved/Date
Permit $125.25 MAM 02/18/03 54989 APPROVED
Plan Check $81.41 MAM 02/18/03 54989
State Building Code $4.50 MAM 02/18/03 54989 FEB 2 0 2003
Total: $211.16
Jefferson County Planning
iYL &Building Dep tment
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Project Description:
Building Type: Project Type: Frame Type:
❑ Single Family ❑ New Wood
Garage Attached Detached ❑ Addition ❑ Steel
❑ Modular ❑ Alteration/Remodel ❑ Concrete •
❑ Commercial IK Repair ❑ Masonry
❑ Multi-family/#of Units ❑ Demolition ❑ Other:
❑ Industrial
❑ Other:
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 ❑ Other
Permit# SEP
Water Supply:
❑ Private well ❑ Two Party Well❑ Public:Name of water system:
Square Footage: For Office Use Only
Main Floor Consistency Review
2ND Floor Base fee / 5-: 2-S---
3rd Floor Plan Check fee—655% ZS L • y/
Htd Basement State Surcharge fee V :;-t-
,
Unhtd Basement Subtotal ( 9 l6/l
Garage/Carport Pot Water Review fee 'C
Decks 911/Rd Approach fee —
Commercial TOTAL -ie/! •
Industrial Receipt# 3 Y 9
Other Cash/Check# ____/// 3c
Total Valuation: Initials
Or Date r4 — / Q
Estimated Cost: �, coo
If within 20 of the Shoreline,
Distance to Ban or Ordinary High ter Mark ft.Bank Height ft.
By signing the application he cant/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 structure shall be requested and shall occur during regular business hours.
Signature: ' 411 1n.M Date: //// 3
ial
OVER
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