HomeMy WebLinkAboutBLD2004-00504 SUILDING PERMIT 1.6N B Review 4
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00504 Received Date: 7/30/2004
SITE ADDRESS: 113 EAGLE VIEW LN
PORT LUDLOW, 98365
OWNER: JAMES GIGER PHONE: 360-437-9141
113 EAGLE VIEW LANE
PORT LUDLOW WA 98365
SUBDIVISION: BRIDGEHAVEN DIV 6 Block: Lot: 30
PARCEL NUMBER: 935400030 Section: 9 Township: 27 N Range: 01 E
CONTRACTOR: C H S PHONE: (360)732-4585
PO B 518 OX
AUBURN WA 98071-0518
Contractor's License CHSIN**9790Z Expires 09/06/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION CHANGE OUT 250 GAL ABOVE GROUND PROPANE TANK
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW
VALUATION MAIN:
CODE EDITION: 2003 ADD'L: HEAT TYPE:
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM: 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
�3� u 7 Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 ZAN 07/30/04 66575
Total: $48.00
PROPANE/PELLET/WOOD STOVE & TANK INSTALLATION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD04-00504 Received Date 7/30/2004
SITE ADDRESS: 113 EAGLE VIEW LN Issue Date 7/30/2004
PORT LUDLOW, 98365
APPLICANT: JAMES GIGER PHONE: 360-437-9141
113 EAGLE VIEW LANE
PORT LUDLOW WA 98365
30
SUBDIVISION: BRIDGEHAVEN DIV 6 Block: Lot:
PARCEL NUMBER: 935400030 Section: 9 Township: 27N Range: 01 E
CONTRACTOR: C H S PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CHSIN**9790Z Expires 09/06/2004
OWNER, JAMES GIGER PHONE: 360-437-9141
if different: 113 EAGLE VIEW LANE
PORT LUDLOW WA 98365
PROJECT DESCRIPTION: CHANGE OUT 250 GAL ABOVE GROUND PROPANE TANK
THIS PERMIT IS VALID FOR ONE YEAR AND IS NOT RENEWABLE.
THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR.
THE EXPIRATION DATE IS 07/30/2005.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: ,tiJG R_Ati!'EMA-,0 6/A
[ ] FinalApproval: 4ha-/ 0_7X5,----
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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JEFFERSON�UNTY •
•
' DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street • Port Townsend •Washington 98368
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360/379-4450 • 360/379-4451 Fax
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p� www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA:
Project Description(include separate sheets as necessary): C 14 (, Pi Ch(.•)T pee)?A A. ri % /}i.' /c)
Tax Parcel c 5- Property
Number: (?, c 2'e� =?� Size: (acres/square feet)
Site Address and/or Directions to Property:
Property Owner(s)of Record: *-rA xi E S !~t<,:/'
Telephone: V 3 ' - `/r(/ / Fax: email: -
Mailing Address: ) l3 t< i3l,(r t.'/Etc) ( A r`-)E aleT (Lui)(La) W3E.5
Applicant/Agent(if different from owner):
Telephone: 4/.3 7' CO V I Fax: email:
Mailing Address: -SAS-/ri
What kind of Permit?(Check each box that applies)
❑ Building ❑ Variance(Minor, Major or Reasonable Economic Use)
❑ Demolition Permit ❑ Conditional Use[C(a), C(d),or C]**
❑ Single Family ❑ Discretionary"D"or Unnamed Use Classification
❑ Garage Attached/Detached ❑ Special Use(Essential Public Facilities)'"
❑ Manufactured Home ❑ Boundary Line Adjustment
❑ Modular ❑ Short Plat**
❑ Commercial* ❑ Binding Site Plan**
❑ Change of Use ❑ Long Plat"*
❑Address I I Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments**
15�Propane ❑ Plat Vacation/Alteration**
❑Plowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions**
❑ Stormwater Management ❑ Shoreline Management Substantial Development**
❑ Site Plan Approval Advance Determination (SPAAD)* ❑ Shoreline Management Variance
❑Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment
LI Forest Practices Act/Release of Six-Year Moratorium
*May require a Pre-Application Conference **Requires a Pre-Application Conference
Please identify any other local, state or federal permits required for this proposal, if known:
DESIGNATION OF AGENT
I hereby designate to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE Date:
By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of
his,her or it's knowledge. Any material falsehood or any omission of a material fact made by the owner/agent 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 its employees,representatives or agents for the sole purpose of application
review and any7uired later inspections.Access and right of entry to this property shall be requested and shall occur only during regular business
hours. Zy���(�- ` I') ,�,�
Signature: � C-" L-
-J Date: 17/ C '
i
The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or
endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the
"Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this
permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your
action(s)eve ' u are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non- nsferab ponsibility for adhering to siid complying with the ESA. The Applicant has read this di�in gr nsign and ates it below.
Signature: -' O-' 9 /). , -- -, Date: 7
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc