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BIJILDING PERMIT
City of Port Townsend
Development Services Department
250 Madison Street, Suite 3, Port Townsend, WA 98368
(360)37e-s09s
Proiect Informatiott
Permit Type Residential - Addition/Remodel
Site Address 4755 HAINES STREET
Project Description
Remodel roof by adding domers, skylights, new windows
Permit #
Project Name
Parcel #
BLD07-164
REMODEL ROOF
93330030r
Numes Associated with this Project
Type Name
Applicant Hulbert Todd
Owner Hulbert Todd
Contact Phone #
License
Type License # Exp Date
Fee Informatiott
Project Valuation
Technology Fee for Building Permit
Building Permit Fee
PIan Review Fee
State Building Code Council Fee
Record Retention Fee for Building
Permit
$20,000.00
Pro.iect Details
Entered Bid Valuation 20,000 DoLt
6.43
321.25
208.8 r
4.50
10.00
Units:
Bedrooms:
Bathrooms
Heat Type:
Construction Type
Occupancy Type:
Total Fees $ 550.99
CalI 385-2294 by 3:00pm for next day inspection.
Permits expire 180 days from issuance if work is not commenced, or if work is suspended for a period of 180
days. Work is verified by obtaining a valid inspection.
Thegrantingofthispemitshall notbeconstnredasapproval toviolateanyprovisionsofthePTMCorotherlawsorregulations. Icertify
that the information provided as a part of the application for this permit is true and accurate to the best of my knowledge, I further certify
that I am the owner ofthe properfy or authorized agent ofthe owner.
Date lssued:Print Name
rssued By:
Signature Date Date Expires:
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Atplicaat
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ryls
Dats lcruad
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hoieutl{ame
Zoning
Date $ubmitted
Ter.bnically Completo
Sate Approvsd
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Development Setvices
Residential Building Permit Application
) Applications accepted by mail must include a check for initial plan review fee of $150
F See the "Residential Building Permit Application Requirements" for details on
plan submittal requirements.
250 Madison Street, Suite 3
Port Townsend WA 98368
Phone: 360-379-5095
Fax: 360-344-4619
.cityofpt.us
Lender lnformation:
Lender information must be provided for projects
over $5,000 in valuation per RCW 19.27.095.
Name: C,rfJ\hC
Project Valuation: S WrOO A
Building I nformation (square feet):
1"tfloor "1>o Garage: lt/Ohe
2nd floor >o Deck(s):'25"-
3'd floor iuLor^Q- Porch(es):_
Basement: wor^Q ls itfinished? Yes No
Carport: r,n0 u.€
Manufactured Home i
New i Addition 1
ADU i
Remodel/RepairContractor: {Same as OwnerName: ' \
OOOru
City/SUZi
Phone:
State License #:_Exp:_
City Business License #:_
Print Name:du 6tA
1r//u' A^-fu<ttn'<
Total Lot Coverage (Building Footprint):*
Square feet: -lk "/" llf:
fmpervious s.qrfqqei. ll 5 Z grirlir'.5
NU NEW
Square feet: F,p{rosdd
*@
Any known wetlands on the property? Y(D
Any steep slopes (>15o/ol? Y(D
I hereby certify that the information provided is correct, that I am either the owner or a
and that all activities assopiated with this permit will be in accordance with State Laws
uthorized
and the
t'
to act an behalf of lfe owner
Port Townsend Municipal Code
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Project Address:
4:t sS ttr*rues sT.
Legal Description (or Tax #)
Addition: T3rA.C'Le-+S
Btock: lSLr><,L 3
Lot(s)a+ 3
Office Use Onlv
#
Associated Permits:
Zoning: R[
Parcet# q B3 7oo 7p1
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GontacURepresentative:
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Address:
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Phone: feil; "t-dd t{"1 lenf
Email:
Signature:
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fxisting Site Conditions
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ond Mudro Bengon
Port Townsend, VA 98368
Site, 4755 Hoines St
Pont Townsend, VA 98368
Tox ID Nor 93330030iLots ? & 3 Block 3
Bnocken's Addition
Jeffenson County WA
Sec, 34, Twp, 31, Rge, lV, , V,M,
Todd HutbentP[ Box 1792
SITE DESCRIPTION AND LOCATION
Site*
Todd Hulbert and Mudra Bergan
4755 Haines Street
Port Townsend WA 98368
*Former address was incorrectly listed.as:
303 4gth Street and may still be listed as such on some Port Townsend Records
Legal Description
Tax Parcel No: 933300301
Lots2&3inBlock3ofthe
Bracken's Addition, Jefferson County, Washington.
Sec 34, Twp. 31 N. Rge. I W., W.M.
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Gity of Port Townsend
Elevelopment Services @partment
250 Madison Street, Suite 3, Port Townsend, WA 98368
(360)379-5095
lnvoice
Date 18-SEP-08
lnvoice #. - 51i-
HULBERT TODD
MUDRA BERGAN
PORT TOWNSEAID WA 98368-0209
Application No BLD07-164
Project: REI\4ODEL ROOF
ApplicalionType Residential-Addition/RenDdel
Parcel # 933300301
Subdivision: BRACKEN'S ADDITION
Site Address: 4755 l-tAlNES STREEr
BlocldLot
Description
Technology Fee for Building Permit
Building Permit Fee
Ran Review Fee
State Building Code Council Fee
Record Retention Fee for Building Fermit
Fee Anlount
$6.43
$321.25
$208.81
$4.50
$10.00
Paid/Credit
$0.00
$0.00
$150.00
$0.00
$o.oo
Balance Due
$6-43
$321.25
$58.81
$q.so
$10.00
Total Fee An)ount:
Total I+rid/Credits:
$550.99
$150.00
Balance Due $400.99
Payment due within 30 days
Page 1
Recept Nunben
BLD07-164 933300301 Plan Review Fee $208.81 $150'00
Total: $150.00
$s8.81
CHECK 3141 $ 150.00
Total $150.00
genprntrreceipts Fage 1 of 1
CITY OF PORT TOWNSEND
PERMIT ACTIVITY LOG
PERMTT# tslp o1 - 164
SCOPE OF WORK:
DATERECETvED 8 - 7 -^7
R
DATE ACTION INITIALS
8- =- n-7 ENTERED INTO CHET ,arlt t l-
CA - to Planning - No evidence /
CHECKED FOR COMPLETENESS
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Parcel Details Page 1 of2
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ParcelNumber: 933300302
Parcel Number: 933300302
Owner Mailing Address:
ERNIE PELHAM
2306 HENDRICKS ST
PORT TOWNSEND WA9B36B7O11
Site Address:
Section:34
Qtr Section: SE7/4
Township:31N
Range:1W
School District: Port Townsend (50)
Fire Dist: Port Townsend (B)
Tax Status: Taxable
Tax Code: 100
Planning area: Port Townsend (1)
LAND
0 6
Sub Division: BRACKEN'S ADDITION
Assessor's Land Use Code: 9100 - V
Property Descri
BRACKEN'S ADD NlBLK3LOrll I
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SEARCH
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Data
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Iax, A/V, Sales Info & Surveysap Parcel
http ://www. co j efferson.wa.us/assessors/parcel/parcel detail. asp 7 t31t2009
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