HomeMy WebLinkAboutBLD2003-00301 • BUILDING PERMIT APPL•TION MLA03-00265
Review Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00301 Received Date: 5/14/2003
SITE ADDRESS: 440 HOYT RD
NORDLAND, 98358
OWNER: DEAN E ROBNETT PHONE: (360) 385-0233
JUDY E ROBNETT
PO BOX 113
NORDLAND WA 98358-0113
SUBDIVISION: OLSON & HAMBLETON'S Block: Lot: 5
PARCEL NUMBER: 977700006 Section: 4 Township: 29 N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION SUN ROOM
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP ADD MAIN:
VALUATION 20,445.00 ADD'L: HEAT TYPE: UH
CODE EDITION: 1997 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: # OF STORIES:
OCCUPANCY:
CONST TYPE: OTHER: 143 SHORELINE:
CONST TYPE: GARAGE: SETBACK: 40
DECK: BANK HEIGHT: 50
SEWAGE DISPOSAL: OSS
WATER SYSTEM: PWELL 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_
-1) /e 0 3 Shoreline _Aquifer _
Forest: Commercial Rural
Type Amount Paid Bv: Date: Receipt: Approved/Date
Permit $335.25 MAM 05/16/03
Plan Check $217.92 MAM 05/16/03
State Building Code $4.50 MAM 05/16/03
Total: $557.67
0 Jefferson Iy Department of Immunity Development
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��� r �,(& t 14 0 621 Sheridan Street,Port Townsend WA 883681360]378-4450
4.* " .e''''.a.'"!'- ,..., Per M 6 tA -pp - 00cato0on
Project Description:
Building Type: Project Type: Frame Type:
❑ Single Family ❑ New ❑ Wood
❑ Garage Attached/Detached 4- Addition X, Steel
❑ Modular ❑ Alteration/Remodel ❑ Concrete
❑ Commercial ❑ Repair ❑ Masonry
❑ Multi-family/#of Units ❑ Demolition ❑ Other:
❑ Industrial
jk. Other: i 1g1 >` D Si/Ai i e)C A/
Bathrooms: Bedrooms: Type of Sewage Disposal: Type of Heat:
Choose one:
Existing: I Existing: .2 ❑ Sewer ❑ Community System ❑ Electricity ❑ Oil
Proposed: Proposed: At Individual System ❑ Woodstove ❑ Propane
Total: I Total: If not sewer,fill out the following: ❑ Heat Pump
❑ Conventional ❑ Alternative g Other t 1 EA i 6b
Permit# SEP
Water Supply:
--Private well ❑ Two Party Well❑ Public:Name of water system:
Square Footage: For Office Use Only
Main Floor Consistency Review 47.00
2ND Floor Base fee 3 3 5 . a 5
3rd Floor Plan Check fee—65% oZ t 1 . I Q oQ
Htd Basement State Surcharge fee I , 5 U
Unhtd Basement Subtotal (pcc1. iiii
Garage/Carport Pot Water Review fee
Decks 911/Rd Approach fee
Commercial TOTAL 6904w 67
Industrial �- Receipt# Sb Oag
Other u / 77
( 3 ,Q.5 Cash/Check# 1 9 y
Total Valuation: Initials ,,,_' Ai/
Or Date , s/! 1 03
Estimated Co : 4-1zS
If within 20 othoreline,Distance to Bank or Ordinary High Water Mark 7 ft.Bank Height 5_0 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 pro or c all be requested and shall occur during regular business hours.
Signature: Date: 5-- 7._Q3
OV
H:HOME\PLNCNTR\INFOBLDG\FORMS\BLDpermitApplication 11-8-01
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