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Home My WebLink AboutBLD2004-00569 IDB BUILDING PERMIT APPLIC BLD04-00569 �N Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD04-00569 Received Date: 9/9/2004 SITE ADDRESS: 23 FAIRBREEZE DR PORT TOWNSEND, 98368 OWNER: DONALD J DIDJURGIS PHONE: VALETTA J DIDJURGIS 23 FAIRBREEZE DR PORT TOWNSEND WA 983689523 SUBDIVISION: KALA POINT#5 Block: Lot: 279 PARCEL NUMBER: 965000162 Section: 27 Township: 30 N Range: 01 W CONTRACTOR: SUBURBAN PROPANE PHONE: 379-5409 P 0 BOX 989 PORT TOWNSEND WA 98368 Contractor's License SUBURPL044DA Expires 03/12/2005 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION NO MLA REQ'D -ABOVE GROUND 120 GALLON PROPANE TANK & HEAT STOVE TYPE OF WORK NON SQUARE FOOTAGE: 'TYPE OF IMP NEW MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2003 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: 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 CJZ 09/08/04 67624 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 #: BLD04-00569 Received Date 9/9/2004 SITE ADDRESS: 23 FAIRBREEZE DR Issue Date 9/9/2004 PORT TOWNSEND, 98368 APPLICANT: DONALD J DIDJURGIS PHONE: VALETTA J DIDJURGIS 23 FAIRBREEZE DR PORT TOWNSEND WA 983689523 279 SUBDIVISION: KALA POINT#5 Block: Lot: PARCEL NUMBER: 965000162 Section: 27 Township: 30N Range: 01W CONTRACTOR: SUBURBAN PROPANE PHONE: 379-5409 P 0 BOX 989 PORT TOWNSEND WA 98368 Contractor's License SUBURPL044DA Expires 03/12/2005 OWNER, DONALD J DIDJURGIS PHONE: if different: VALETTA J DIDJURGIS 23 FAIRBREEZE DR PORT TOWNSEND WA 983689523 PROJECT DESCRIPTION: NO MLA REQ'D -ABOVE GROUND 120 GALLON PROPANE TANK & HEAT STOVE 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 09/09/2005. REQUIRED INSPECTIONS: [ dep in- GK .9/30orf� • [ ] FinalApproval: (:)1< —2r- -i 111'0 I 9' 34 C7 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 : \ ' - . .......,- ‘) . . 1': I" =1-4O' e 4 \ - . • • 10 - . ,e• \ 1 . - , fo 15F3.22' ,C) (7 41) .1-- \ v V W 111 ' 1 Y t or W o ,_,._ • ; fit 1 \ . .. -:. ____—Lc, • -1E-LtA ,---0-?.., tif '' : . , fr.,,REA , \\ / . • . ,i� •• .. • • • • 7 _ . \ Legend ii I 6. \-14 Contour Lines- • PJNECI2EST DZ• Property Lines. . Roadway Drainage. O Water Tap Q Phone Tap O Electrical Tap O 3/4 " Iror Pipe APFA: 1783`T 5Q. fl. [LOU 27i9 xada pua o Dovo [B0. 5 loniik4,,soNt, 6 JEFFER• COUNTY • j DEPARTMENT OF COMMUNITY DEVELOPMENT $44 621 Sheridan Street• Port Townsend •Washington 98368 - 360/379-4450 • 360/379-4451 Fax k' O www.co.jefferson.wa.us/commdevelopment �`S1:ING' Master Permit Application MLA: Project Description(include separate sheets as necessary): Tax Parcel // //,^ Property Number: (7 S CC'C / W 2 Size: ,S A (acres/square feet) Site Address and/or Directions to Property: 2,3 Vet t c-isRaze Property Owner(s)of Record: a-p 4 ti a ccortr Telephone: Sb3 6 i/ /(-0-/ Fax: email: Mailing Address: 23 Fill o...3 it.r2ed Applicant/Agent(if different from owner): !i-P_/ /4 S E i°P Telephone: .3 A- 51/c5(o (3 (3) Fax: S At-1-6 email: Mailing Address: SC Z 1344ky L L I F F Dfz t I!c What kind of Permit?(Check each box that applies) U 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 0 Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** a'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 *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 �� Sl C�� to act as my agent in matters relating to this placation for permit(s). OWNER SIGNATUR L'6 "".'s A co,-- v`-' Date: 9 "'//� By signing this application ,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!hie 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 any r uir d later inspec s.Access and right of entry to this property shall be requested and shall occur only during regular business hours. / 0 Signature: A --t_ �l Date: 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 beeryissued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)ev if y are m p i.nce with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non- sfera res ibi for a..- 'ng to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: _ / Date:• G:\PemutCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc • OWNER BUILDER STATEMENT • The signer of this statement.. hereby certify th ey are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assuming ':1 ii, of the �iL� for the proposed project. / 1' �r� b ti GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: t S l'11 ...4 r-t 4'1 -�.:7==n `5 . 0—Gn., lc_d , ( 36:U ) <3 Rs ;;i:(c ( ) 0 A (LING ADDRESS: I S J 13 L. L`i0 i_ [.;-j c( j' I EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: 2 1v F i X /4- FL-e}i-7c, t L L NUMBER - Fix%>t FL * C G:,/ -, -Z PHONE (3C,C)) (,'J f 7f FAX:( ) MAILING ADDRESS: EMAIL Project Type: frame Type: Bathrooms: I Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: 0 Sewer [1 Addition ❑ Steel Proposed: Bank ❑ Community System Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ Repair 0 Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: ❑ Public PktlPApi✓ Total: Name of System: If this is a Commercial Prolect you must answer the following: v114 Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current Proposed IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: ❑ Underground Tank Above ground Tank Size of Propane Tank: j Z.0 G AL. XHeat Stove 0 Cook Stove 0 Woodstove 0 Fireplace Insert t 1 Hot W- -r Tank ❑ Pellet Stove ❑ Other Is this appliance being installed in a Manufactured/Mobile Home? Yes ,0 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. Square Footage For Office Use Only n Current Proposed Amount 11 Main Floor Consistency Review: ,'r � 2NU Floor Base fee: 3°Floor Additional Section: Mezzanine: Plan Check fee: v. Heated Basement State Surcharge fee: Unheated Basement Pot Water a ee: Other Unheated 911/Rd Approach fee: fi Garage/Carport TOTAL: $ Decks Receipt Number: Other Cash/Check Number: t ), ESTIMATED COST(REQUIRED) Dater .Fair market value of all labor and materials foundation to finish , Initials: G:\PennitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc