Loading...
HomeMy WebLinkAboutBLD2003-00139 0 BUILDING PERMIT APPLI!TION MRLA03 00104 eview Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD03-00139 Received Date: 3/6/2003 SITE ADDRESS: 2434 DUCKABUSH RD BRINNON, 98320 OWNER: JUDITH C ASHLEY PHONE: (360)796-3004 2134 DUCKABUSH RD BRINNON WA 98320-9624 SUBDIVISION: Block: Lot: T 4+ PARCEL NUMBER: 502082004 Section: 8 Township: 25 N Range: 02 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: LAWRENCE DIMINO PHONE: (360)796-3068 PO BOX 218 BRINNON WA 98320 PROJECT DESCRIPTION GARAGE /-ADS TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP ADU MAIN: VALUATION 60,000.00 ADD'L: 660 HEAT TYPE: HTP CODE EDITION: 1997 HEAT BASE: HEAT TYPE: OCCUPANCY: OCCUPANCY: UNHEATED: #OF STORIES: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: 600 SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: OTHER PARCEL TAGS: YES NO BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA Exist: Exist: Wetland Erosion Prop: 1 Prop: 2 Seismic Streams Total: 1 Total: 2 Flood Way Floodplain Routing Date: - F&W Landslide " , (( >( v-� Shoreline Aquifer Forest: Commercial Rural Type Amount Paid By: Date: Receipt: Approved/Date Permit $713.75 MAM 03/06/03 55078 Plan Check $463.94 MAM 03/06/03 55078 State Building Code $4.50 MAM 03/06/03 55078 Total: $1,182.19 &tedisEt7.&* 0 3 • Masson Mty Department of Community Devdoonemt �� oN eon 621 Sheridan Street,Port Towed WA 08368 13601 378-4450 4. Perm 6 11 AppIcj© 4`9hrlN Project Description: Building Type: Project Type: Frame Type: X Single FamilyAl? New S Wood ❑ Garage Attached/Detached ❑ Addition ❑ Steel ❑ Modular ❑ Alteration/Remodel 0 Concrete ❑ Commercial ❑ Repair ❑ Masonry ❑ Multi-family/#of Units 0 Demolition ❑ Other: ❑ Industrial ❑ Other: Bathrooms: Bedrooms: Type of Sewage Disposal: Type of Heat: Choose one: 0 Existing: Existing: ❑ Sewer ❑ Community System ❑ Electricity ❑ Oil Proposed: 7S. Proposed: / AA-Individual System 0 Woodstove ❑ Propane Total: 1 ��"_ Total: If not sewer,fill out the following: XHeat Pump ` K'Conventional ❑ Alternative ❑ Other Permit# SEP '7 5----4-�9 Water Supply: (p J s'-frelx.st. wa-fe-c 9l �eivt. ❑ Private well ❑ Two Party Well❑ Public:Name of water system: t Square Footage: For Office Use Only Main Floor L� Conit'r.1 4ute-41) sistenry Review ` - 2ND Floor t P '1 Base fee "13. 7 5 3rd Floor Plan Check fee—65% 3 a((tI Htd Basement State Surcharge fee ii T. 3 Unhtd Basement /� Subtotal lb Gara/Carport Orl f r Poo() 660 5�"(f�Q�`" of Water Review fee 0 Decks r \ 911/Rd Approach fee (� Commercial �� � TOTAL ( Z , r 19 Industrial Receipt# 5 Other Cash/Check# -7 Total Valuation: __- �) Initials 'Pt Or Date 6 3 Estimated Cost *�0, 000 j 0 0�' /� If within 200' of t ie S reline, 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 sted and shall occur during regular business hours. Signature: Date: ..71-/c /o OVER -0- H:HOME\PLI OBLDG\FORMS\BLDpermitApplication 11-8-01 _ � F