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Home My WebLink AboutBLD2004-00560 BUILDING PERMIT APPLIITION B RD04 00560 Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD04-00560 Received Date: 9/7/2004 SITE ADDRESS: 1545 THORNDYKE RD PORT LUDLOW, 98365 OWNER: ROBERT S WINSLOW PHONE: REBECCA J WINSLOW 1545 THORNDYKE RD PORT LUDLOW WA 983658221 SUBDIVISION: TRAILS END HOMESITES Block: 3 Lot: 19 PARCEL NUMBER: 950100318 Section: 16 Township: 27 N Range: 01 E CONTRACTOR: FERRELLGAS PHONE: (360)582-0231 646 SO 3RD AVE SEQUIM WA 98382 Contractor's License FERRELP055LH Expires 8/1/2006 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP PROPANE LINE EXTENSION AND VENTER RADIANT HEATER 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: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: 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 Shoreline Aquifer — Forest: Commercial Rural Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $48.00 PRB 09/03/04 67555 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#: BLD04-00560 Received Date 9/7/2004 SITE ADDRESS: 1545 THORNDYKE RD Issue Date 9/7/2004 PORT LUDLOW, 98365 APPLICANT: ROBERT S WINSLOW PHONE: REBECCA J WINSLOW 1545 THORNDYKE RD PORT LUDLOW WA 983658221 19 SUBDIVISION: TRAILS END HOMESITES Block: 3 Lot: PARCEL NUMBER: 950100318 Section: 16 Township: 27N Range: 01 E CONTRACTOR: FERRELLGAS PHONE: (360)582-0231 646 SO 3RD AVE SEQUIM WA 98382 Contractor's License FERRELP055LH Expires 8/1/2006 OWNER, ROBERT S WINSLOW PHONE: if different: REBECCA J WINSLOW 1545 THORNDYKE RD PORT LUDLOW WA 983658221 PROJECT DESCRIPTION: PROPANE LINE EXTENSION AND VENTER RADIANT HEATER 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 9R/2005. REQUIRED INSPECTIONS: [ ] Tank/Line/Appliance: I jrice pieGp,o,ue L,NE Lk 0 V [ ] FinalApproval: OK AS'EMP5R1? Y /1)5-7-10/41 Op /07, 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 I:\F_BLD_Permit_Propane.rpt 10/29/19 • OWNER BUILDER STATEMENT 40 The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be.assuming the responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: 1— ( :: -\C - FAX: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) Fm:( ) MAILING ADDRESS: EMAIL P ❑r�t Type: Frame Type: Bathrooms: I Shoreline: Type of Sewage Disposal: ❑ Wood Existing: 0 Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Height: ❑ Individual lt Alteration/Remodel ❑ Concrete Total: ❑ Community SystemSyem ❑ Repair ❑ Masonry SEP Permit# 0 Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: pp y: Type of Heat: Proposed: ❑ Private well 0 Two Party Total: 0 Public Name of System: If this is a Commercial Project you must answer the following: Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current IBC Occupancy: Proposed IBC Type of construction: Will you have Food Service? Yes / No �i -�Z P If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: ❑ Underground Tank .',Aboveground Tank VADIA'� (�7� Size of Propane Tank: `t' ❑ Heat Stove ❑ Cook Stove ❑ Woodstove ❑ Fireplace Insert ❑ Hot War Tank ❑ Pellet Stove ❑ Other XNtt=e,K,iG J Is this appliance being installed in a Manufactured/Mobile Home? Yes No / When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property lines,tank location and size,distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. ISquare Footage For Office Use Only I Current Proposed . . Amount Main Floor Consistency Review: .... 2N"Floor Base fee: 3°Floor ¢• � Additional Section:. Mezzanine: Plan Check fee: f Heated Basement State Sur charge fee: r Unheated Basement Pot Water Review fee: Other Unheated 911/Rd Garage/Carport TOTAL. $ Decks �` Receipt Number: :11,11 .,,,;7,,,,:,, Other tFJ Cash/Check Number 211 0 ESTIMATED COST(REQUIRED) Date: •Fair market value of all labor and materials foundation to finish r C Q a+ Initials: G.\PemvtCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc 1N3Wd013A30�llINf1WW00 30'1d30 �4,,�`SoN cod JEFFERSOt UNTY /.1N(100 NOSH3333t' III ` �" DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend •Washington 98368 MO? E - des 360/379-4450 • 360/379-4451 Fax p� vvww.co.jefferson.wa.us/commdevelopment --_ �SFiING'' J� tl c � a Master Permit Application MLA: Project Description(include separate sheets as necessary): 17%I c c;L.(- L-(N— sir_--r n=.efU/J c Ni WqO va-\DIAI1 1-1 A-te-e_ Tax Parcel 3p, Property Number: y (J/00, �`�G� 1 (acres/square feet) Site Address and/or Directions to Property: /c3 4 7NG),?!si 0/' i= i D Property Owner(s)of Record: cr7E2r Pe i3 A wi/u5c.c,''v Telephone: h D- g —i p Fax: email: ribb,t c4/: 60/11 Mailing Address: /6i41i T-tD.enii-V,<c ni-' . ,i'r Pi- w iA/i4 9 &I - Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies) IABuilding ❑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 Li Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** Propane ❑ Plat Vacation/Alteration** ❑Allowed"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 ❑ Forest Practices Act/Release of Six-Year Moratorium **Requires a Pre Application Conference *May require a Pre—Application Conference �1 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). Date: OWNER SIGNATURE 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 nu!!and void. I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attomey'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, beepreset d and shalpresentatives or l s occur the duringol purpose ser of application review and any required later inspections.Ancf* c and right f entry to this property ,/ hours. �==�' Date: �/ ` '> f~�! �( Signature: � � /\ 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)even if you are in compliance with the Jefferson unty development code.The Applicant acknowledges that he,she or it holds individual and non-transferable responsty for erin anti plying with the ESA. The Applicant has read this disclaimer and signs and dates it below. ._"---le ,------ Date: 9-5 -U 4. Signature: � `� �---- > G:\PemutCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc \. • i q- . • p, ' i I `� • y no (o -v m t -d s n . % t a A -1. c_, u P n i Q "1' F 1 • D T a a1 s s S' \ A j G �\ 51C .- j N \ 1i 1 a +—t- 0 ,_____r___ , , •, P I h I y } 0 I ilb Z. .,,.....) ',-.'a , N • • e. \ , -E.- O l'..c >_j c, .______,, 1 v _ 3� IN L E-+ 0 • IM a • {0{ 2 N —1- . x- i; ----.. r--.-- , _.- t Z y P. 6 tv o p.."‘C.::3 rn y' IV ra) • O • Nm Ctob � �o <.MI rg• n�t�< � u r� C70 �i �] • Cif m C� bib, g �• Y C7 I► O