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c&lrclzo Develvpment Selvfces
Residential Building Permit Application
) Applications accepted by mail must include a check for initial plan review fee of $150) See the "Residential Building Permit Application Requirements" for details on
plan submittal requirements.
Property Owner:
Name
Address: 3"LbS Efe{silb+E.t
City/SUZip: ?apT Taw'.\5b{D d VA gbbbt!
Phone
Email:
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I hereby certify the i
and that all
Print Name
Any known wetlands on the property? Y N
Any steep slopes (>15%l? Y N
provided is correct, that I am either the owner or authorized to act on behalf of the owner
with this permit wilt be in accordance with State Laws and the Port Townsend Municipal Code
Project Address:
,i'LbS €a\St****Legal (or Tax #):
Addition
Block:
Parcel #4 a9st 7o \\c,Lot(s
Project Description tq€r: t \P EF\LL
Lender lnformation:
Lender information must be provided for projects
over $5,000 in valuation per RCW 19.27.055.
Name
Project Valuation:$ 'b-p o5 \st)
Co ntacURepresentative :Name: O \A\l'\6-g
Address
City/SUZip:
Phone:
Email
,t r I \\ ,'t
Contractor:
Name
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City/SUZi
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Email:
State License #Exp:--
City Business License #:
Building lnformation
1'tfloor \35tb b$
(square feet):
Garage:_
2nd floor
3'd floor
i9G s('Deck(s
Porch(es):_
Basement: ls it finished? Yes No
Other:
Manufactured Home fJ ADU !
*"W Addition n Remodet/Repair !
Total Lot Goverage (Bui lding Footprint):
Y, rb.4"i"Sq uare feet: La \\
lmpervicus Surface:
Sq uare feet: 5;"f grC u""f .
\l\,usig Date:\L V'%Y' o 6()
RESIDENTIAL BUILDING PERMIT APPLICATION
CHECKLIST
This checktist is for new dwellings, additions, remodels, and garages. The purpose ls fo show
what you intend to build, where it will be located on your lot, and how it will be constructed.
I Residential permit application.
tr Washington State Energy & Ventilation Code forms
n Two (2) sets of plans with North arrow and scaled, no smaller than /o" = 1 tool:.
f A site plan showing:
1. Legal description and parcel number (or tax number),
2. Property lines and dimensions
3. Setbacks from all sides of the proposed structure to the property lines in accordance with a
pinned boundary line surveY
4. On-site parking and driveway with dimensions
5. Street names and any easements or vacations
6. Location and diameter of existing trees
7. Utility lines
B. lf applicable, existing or proposed septic system location
9. Delineated critical areas boundaries and buffers
I Foundation plan:
1- Footings and foundation walls
2. Post and beam sizes and spans
3. Floor joist size and layout
4. Holdowns
5. Foundation venting
I Floor plan:
1. Room use and dimensions
2. Braced wall panel locations
3. Smoke detector locations
4. Attic access
5. Plumbing and mechanical fixtures
6. Occupancy separation between dwelling and garage (if applicable)
7 - Window, skylight, and door locations, including escape windows and safety glazing
tr Wallsection:
1. Footing size, reinforcement, depth below grade
2. Foundation wall, height, width, reinforcement, anchor bolts, and washers
3. Floor joist size and spacing '
;4. Wall stud size and sPacing :
5. Header size and spans
6. Wall sheathing, weather resistant barrier, and siding material
7. Sheet rock and insulation
8. Rafters, ceiling joists, trusses, with blocking and positive connections
9. Ceiling height
10. Roof sheathing, roofing material, roof pitch, attic ventilation
f Exterior elevations (all four) with existing slope of the land in relation to all proposed structures
I lf architecturally designed, one set of plans must have an original signature
J lf engineered, one set of plans must have one original signature
I For new dwelling construction, Street & Utility or Minor lmprovement application
PT DrsreN &
TilneEBFRAME
3265 Edd Street
Port Townsend, WA 98368
Phone: (360) 379-3940
E-mail: ekuzma@bcalnet.com
ekuzma@lotyrnpus.net
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CITY OF PORT TOWNSEND
J{VELOPMENT SERVICES DEPARTM, i.\
Waterman & Krtz Building, l8l Quincy Street, Suite 30tA
PortTownsend \ryA 98368
Phoner 360-379-3208 Fax360-JB5-7675
RESIDENTIAL BUILDING PERMIT APPLICATION
NEW CONSTRUCTION, REMODELS, & ADDITIONS
for the type of buildi rmit you are
Floor Area: the proposed struciure is to be used for:
Scope of Work:
Please check all items that ap
leOwner's Name(s oz b^
Mailing Address o
-29 ()L 05 -5o5,r,
City, State, Zip
Phone Permit No.
A
Property StreetAddress 3ZA5 LVO SIY+_:-f
District Parcel#Zoni o 6
Legal Description: Addition Block I Lot(s)
General Contractor's Name
Mailing Address O\^,
Phone CellPhone
City Business' License NumberState License Number
Authorized Phone -51Person\)1
Estimated Value of construction $
Financed By
Date Work is to be CompletedDate Work is to Begin
New House Addition
New Garage or Carport Repair/Remodel Garage
Repair/Remodel House Accessory Dwelling Unit
Other (please describe):
Finished Heated Space \es4 s{sq. ft:Garage sq. ft:
Unfinished Heated Space sq ft:Carport sq. ft:
Unfinished Basement sq ft:Porches sq. ft.
Semi-Finished Basement sq ft:Decks sq. ft:
Storage sq. ft:Other (please describe):
P:\DSD\Department Forms\Building Forms\Application-Residential Building permit-doc
Page 1 of 1
1
CITY OF PORT TOWNSEND RESIDENTIAL BUILDING PERMIT APPLICATION
NEW CONSTRUCTION, REMODELS, & ADDITIONS
1. The totalarea of the propefi in square feet:15, ooo Bt
2. The total area covered by existing and proposed structures in square feet:
(total ground coverage from the outside of walls or supporting membeis)2ot\, sf
Percentage of lot coverage: (2+1)\j.t '/.
P Site Area/C e lnfoimation:
rmpervious suf.aces: fr"fg^rtr 2or qtJl'z'8" o'wltu{s
Please provide the square footage of the roof area-qf the proposed and existing.structures, and the square footage of the
total area covered by porches, walkways, patios and driveways. Do not include decks allowing drainage to earth below.
Proposed House Roofpiint sq..ft:Existing House Roofprint sq. ft:
Proposed Garage Roofprint sq. ft:Existing Garage Roofprint sq. ft:
Proposed Porch/Walkway sq. ft:Existing PorchMalkway sq. ft:
Proposed Driveways sq. ft:Existing Driveways sq. ft:
Other (describe):Other (describe):
TotalProposed lmpervious sq. ft:b+'"G sf Total Existing lmpervious sq. ft:
Total Proposed + Existing sq. ft:
-;-------->
Percentage lmpervious: *
(lmoervious surface + lot so. ft)7b'6
*lf total impervious surface is equal to or greater than 40% of the lot area, you must submit a written stormwater plan to
address run-off.
Please check which plans you are submitting with this application (2 sets needed):
Site Plan /lnterior & Exterior Wall Bracing (panellocations
shown on floor plan)
Drainage Plan (if 40oh or more impervious)TypicalWall Framing Details (section from foundation
through roof)
Foundation Plan Elevations
,/Floor Plan 2003 WSEC* Complianc€i Prescriptive[ co.ponent -(Floor Framing Plan WSEC Construction Checklist
Roof Framing Plan ,/Other:Q,-(3--- 1-xil[S
*WSEC = Washington State Energy Code
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i'
CITY OF PORT TOWNSEND RESIDENTIAL BUILDING PERMIT APPLICATION
NEW CONSTRUCTION, REMODELS, & ADDITIONS
Special Conditions
Afrpliea nt Certifi eation
The applicant hereby certifies to have knowledge of those sections of the lnternational Residential Code and thePort Townsend Municipal Code pertinent to the above project and that the applicant is responsible for constructing inconformance with these codes; the applicant understands that the permit, if issued, expires in six months unless work isstarted; that the permit, after construction has started, will expire afier one year if an inspection is not made to showsignificant progress on the structure; the applicant agrees to abide by the ordinances, codes, regulations, restrictivecovenants, deed or plat restrictions; and water and sewer plans attached hereto; the applicant cirtiRes that all informationgiven above and on accompanying plans is complete and accurate to the best of their'knowledge; and the applicantunderstands that this information will be relied upon in granting permits and that if such information is later found to beinaccurate any permits may be withdrawn.
Please check YES or NO as applicable YES NO
1. ls the propbrty within 200 feet of a fresh or saltwater shoreline?X
2. ls the property within the Port Townsend Historical District?X
3. !s the rty located within or adjacent to an environmentally sensitiv e area?x
4' Will this proposal involve any sewer, water or other utility extensions that will, or could serve
vacant properties other than the project site? !f yes, please attach information identifying the utility
extensions and sites.X
5.H ave ny special cond itions been placed on th IS propefi o I has the property been subject to
following, attach copies ofanyconditionsonanypnoractionoftheCity(if 'YCS,,to a ny of the
app ro priate docume nts x
Subdivision/Short PlaUBounda Line Adjustment?
SEPA (environmental review)?
Variance?
Conditional Use Permit?
Street Vacation?
Planned Unit Development?
Restrictive Covenant?
Easement?
6. Are any properties within 800 feet of the site owned
business associate, or any partnership, corporation, or
or controlled by the applicant, any relative or
other entity affiliated with the applicant? (lf r
7- Have any of the properties listed in item #6 been developed within the last two years? (lf yes,
attach list.)r
8- Have you previously discussed this project with a City staff member? lf yes, who and when?
/<
P:\DSD\Department Forms\Building Forms\Application-Residential Building permit,doc
Page 3 of 3
CITY OF PORT \,WNSEND RESIDENTIAL BUILDING PERMIT APPLICATION
NEW CONSTRUCTION, REMODELS, & ADDITIONS
The undersigned hereby saves and holds the City of Port Townsend harmless from any and all causes of action,
judgments, claims, or demands, er from any liability of any nature arising from any non-compliance with any restrictive
covenants, plat restrictions, deed restrictions, or other restrictions which may have been established by parties other than
the City of Port Townsend.
Complete Applieation
Port Townsend Municipal Code, Section 16.04.140, Vested Rights - Substantially Complete Building Permit
Application: applications for all land use and development permits required under ordinances of the city shall be
considered under the zoning and other land use control ordinances in effect on the date a fully complete building permit
application, meeting the requirements identified in this section, is filed with the Development Services Department. Until a
complete building permitapplication is filed, allapplications for land use and development permits shall be reviewed
subject to any zonin$ or other land use control ordinances which become effective prior to the date of issuance of a final
decision by the city on the application.
An application for a building permit shall be considered complete when an application meeting all of the
requirements of Section R105.3 of the lnternational Residential Code, 2003 Edition, is submitted which is consistent with
allthen applicable ordinances and laws. ln addition, to be considered complete, such an app.lication must be
accompanied by complete applications for a subsidiary land use or development permits needed, such as a complete
shoreline management permit application and/or complete applications for other discretionary permits required under the
ordinances of Port Townsend. An application for a partial permit under Section R105.3.1 of the lnternational Residential
Code, 2003 Edition, shall not be considered complete unless it meets all requirements stated above and contains plans for
the complete structural frame of the buildi ng and the architectural plans for the structure.
o
Signature of Date
For Offioial Use Only
Permit No.Building Official Approval Date lssued
Balance Due $Date Validation Stamp below
Owner/Representative Sig nature Date
P:\DSD\Department Forms\Building Forms\Application-Residential Building permit.doc
Page 4 of 4
CITY OF PORT TOWNSEND
PERMIT ACTIVITY LOG
PERMIT #r*c3
SCOPE OF WORK:J
.fr h
DATE RECEIVED Z cy
6Ln r-e,u I g*-e) U,/ldp"^ ?LD /{y_
tlw "lC&-
ACTI
;uA
INITIALS
U ENTERED INTO CHET SrttICA - to Planning - No evidence
CHECKED FOR COMPLETENESS
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