HomeMy WebLinkAboutBLD2003-00529 • Review 0050
BUILDING PERMIT APPLICATION SEP85-00050
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00529 Received Date: 8/19/2003
SITE ADDRESS: 122 MOONDANCE DR
PORT LUDLOW, 98365
OWNER: DANAN N THOMPSON PHONE: (360) 437-0146
122 MOONDANCE LN
PORT LUDLOW WA 98365
SUBDIVISION: JAKUM/MCKAY SHORT PLAT Block: Lot: 1
PARCEL NUMBER: 821334100 Section: 33 Township: 28 N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr CONVERT GARAGE TO RESIDENCE
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 900
VALUATION 60,000.00 ADD'L: HEAT TYPE: PRO
CODE EDITION: 1997 HEAT BASE: HEAT TYPE: WOD
OCCUPANCY: R-3 UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: 3N GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: OSS
WATER SYSTEM: 2WELL PARCEL TAGS: YES NO
BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA
Exist: Exist: Wetland Erosion
Prop: Prop: 1 Seismic Streams
Total: Total: 1 Flood Way Floodplain
Routing Date: G F&W Landslide
O ae (.0•3 Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: A P.". yV E
Permit $713.75 MJA 08/19/03 58386
Plan Check $463.94 MJA 08/19/03 58386 SEP - 8 2003
State Building Code $4.50 MJA 08/19/03 58386 Jefferson County Planning
Potable Water Application $51.00 MJA 08/19/03 58386 & Building Department
Total: $1,233.19 1/44/ L tol
BUILDING PERMIT •
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD03-00529 Received Date 08/19/2003
SITE ADDRESS: 122 MOONDANCE DR Issue Date 09/8/2003
PORT LUDLOW, 98365
APPLICANT: DANAN N THOMPSON PHONE: (360)437-0146
122 MOONDANCE LN
PORT LUDLOW WA 98365
SUBDIVISION: JAKUM/MCKAY SHORT PLAT Block: Lot: 1
PARCEL NUMBER: 821334100 Section: 33 Township: 28 N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
LOAN LENDER/
BOND HOLDER:
PROJECT DESCRIPTION: CONVERT GARAGE TO RESIDENCE
REQUIRED INSPECTIONS:
[ ] SETBACKS: Z.X/S
[ ] UFFER: A
[ ] Footing: £X/$T
[ ] Foundation: S3et51
Underground Plumbing: ,/ fV°7fr
Undergrewtd Insulation: /L
[ ] Shear Wall : Of
[ ] Framing: oil° a --r& p rED @5 g)414 Apt
1 1 Plumbing: O < a(p(()(� � /12aPDSTD Afe *Wee, lillaZt
[ ] Propane/jaatF- LL ?Zen,.Jn As51.t4trrc9.7 DR
[ ] Insulation.V, L-�C-o` A' Co Bi1c eoD *cuur I�Ew.Duces I(Ji s9 Y / I/
( 1 Sheetrock:
[ ] Septic Sytem Final Approval:
1 Zoning Final Approval:
[ ] Final/Occupancy Approval: Dk -Car C/ 844 DL
HEALTH DEPARTMENT APPROVAL REQUIRE P R 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
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w, ° JEFARSON COUNTY .P� aowtt�a �
ti ,4 DEPARTMENT OF COMMUNITY DEVELOPMENT w ( .Ark.-t L grl lD3 f.
4,,, ,. 621 Sheridan Street• Port Townsend •Washington 98368 I D
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q O 360/379-4450 •800/831-2678 • 360/379-4451 Fax
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S7N www.co.jefferson.wa.us/commdevelopment
'AUG 1 9 2003 1 J
Master Land Use Permit Application Form f
PROPERTY INFORMATION - J
nn JtFFi.: SON COUNTY
El 0 ® ® 0 DEPT. OF Ci t "UNITY EVELOp",SENT
Tax Parcel Number: ---
Subdivision
Subdivision Name: 'tea)Curti /rA i. Lot Number: t
Property Size: 14 fi (acres/square feet) Existing Use of Property: 5atl e / rrri yi I 1
)Site Address and/or Directions to Property: .'.L I" oo AAA it 4 c7 Li Art" L-t 1 I , .., &/4 91-
APPLICANT&OWNER(INFORMATION
Applicant(if applicable): Telephone:
Address:
City: State: Zip Code: Email Address
Applicant's Signature:
Property Owner(s)of Record: f;. , n tin y,M `:•;1 Telephone: 63(c c ) H"? 7- C 1 Li C--,
Address: h2`.L j''i,�s,..�f,4ytcC Li.
City: (),, (1"- L,A.A(o„," State: °;,,/,4 Zip Code: 9 %;L,5 Email Address /t/
I acknowledge that the applicant above isis applying for a building permit on my property.
Owner's Signature: /,a_-- r1�/
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)
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[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:
Septic Permit/Evaluation of Existing System(EES)4
UDC Section 6.4.1 and Chapter 8.15 JCC
Building/Demolition Permit UDC Section 3.2.1 and Table 3-1
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
❑ Temporary Use(based on use may be Type II or Type III)` UDC Sections 4.38 and 4.39 (OVER)
• •
111
°&s. JEFFERSON COUNTY -�� ��
4 .;� DEPARTMENT OF COMMUNITY DEVELOPMENT -' I i
AUG 1 9 2003 '�
' '3 621 Sheridan Street • Port Townsend • Washington 98368 ( i
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S4/140" - 360/379-4450 . 360/379-4451 Fax 'T �; ,,aA, A,T
http://www.co.jefferson.wa.us/commdevelopment/
Stormwater Calculation Sheet
MLA# PROJECT/APPLICANT NAME: .f ,,t^0,; --
� � ii,,y,n/, /; 4:1 r/`
This stormwater calculation sheet should accompany stand-alone stormwater management permit applications, building permit
applications, and other land use approval applications that involve stormwater review.
STORMWATER CALULATIONS-IMPERVIOUS SURFACE
NEW EXISTING
Structures(all roof area) sq/ft Structures (all roof area) I 1 '1 L sq/ft
Driveway sq/ft Driveway sq/ft
Sidewalks sq/ft Sidewalks sq/ft
Patios sq/ft Patios sq/ft
Solid Decks sq/ft Solid Decks sq/ft
Other sq/ft Other sq/ft
Total New 0 sq/ft Total Existing t/ 7 sq/ft
TOTAL NEW+TOTAL EXISTING* I /Cj L, 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
Drainfield area cleared sq/ft Well, Structures, Utilities, etc. sq/ft
Driveway sq/ft Other sq/ft
Total Land Disturbance 0 sq/ft
STORMWATER MGMT PERMIT.DOC REV.12/20/02
o o • Jeffersony Department of Community Development
,G� a 621 Sheridan Street.Port Townsend WA 0836813601378-4450
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Permh A
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PP0 - iicalioon ,I 9 2003 ,
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JEFF R " "� ,- OP
� NProject Description: �,,, ,,iTy D: Lc
Building Type: Project Type: - Frame Type:
Single Family V New Wood
❑ Garage Attached/Detached ❑ Addition ❑ Steel
❑ Modular ❑ Alteration/Remodel ❑ Concrete
❑ Commercial ❑ Repair ❑ Masonry
❑ Multi-family/#of Units ❑ Demolition ❑ Other:
❑ Industrial
❑ Other:
Bathrooms: Bedrooms: Type of Sewage Disposal: Type of Heat:
Choose one:
Existing: Existing: ❑ S wer ❑ Community System ❑ Electricity ❑ Oil
Proposed: 1 Proposed: 6 Individual System Eoodstove ropane
Total: j Total: 0 If not sewer,fill out the following: ❑ Heat Pump
❑ Conventional ❑ Alternative ❑ Other
Permit# SEP $5-`'
Water Supply: /�
❑ Private well ri Two Party Well❑ Public:Name of water system:
Square Footage: For Office Use Only
Main Floor 90O c't 2 15 u 1
S 2—
Consistency Review 47.00
2ND Floor Base fee '7/3 • 75
3rd Floor Plan Check fee-65% q6 3 ' 911
Htd Basement State Surcharge fee 1f- S D
Unhtd Basement Subtotal I 229• 1 9
Garage/Carport Pot Water Review fee e-a0 0
Decks 911/Rd Approach fee
Commercial TOTAL 3 •
Industrial Receipt# _ ,; -
Other Cash/Check# E.41
Total Valuation: �_____----- Initials 4111.4
Or ��,,,, Date 'a / )p (�i
//
Estimated C st: l J/0 0 0 %
If within 200' of the Shgrel ne,
Distance to B k or O ary 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 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: /2,, - e/� ---- Date: yi 5/zco3
OVER
H:HOME\PLNCNTR\INFOBLDG\FORMS\BLDpermitApplication 11-8-01
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