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Home My WebLink AboutBLD2004-00818 itILDING PERMIT APPLICATIN B RDOe 00818 Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD04-00818 Received Date: 12/27/2004 SITE ADDRESS: 80 SPARROW LN PORT LUDLOW, 98365 OWNER: PAUL SORRENTO PHONE: MELISSA SORRENTO 5918 MONT BLANC PL NW ISSAQUAH WA 98027-7859 SUBDIVISION: PORT LUDLOW NO. 4 Block: Lot: 17 PARCEL NUMBER: 990500017 Section: 17 Township: 28 N Range: 01 E CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2006 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOt A/G 120 PROPANE TANK, GAS PIPING 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: 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 Shoreline Aquifer Forest: Commercial Rural Type Amount Paid Bv: Date: Receipt: Approved/Date Propane Tanks/Stoves $48.00 KAS 12/27/04 68943 Total: $48.00 . , , „. • SITE VISIT REPORT 0 (PLOT PLAN) -`14. .. JOB 6 7iT/((t5td11 DATE : /./I�j CONTACT: • ADDRESS PHONE #: • DIRECTIONS FAX #: . Email PLANNER: —,q :emu "--- 1 1 ri-, i I I • I , f T)) . CIF, 11141E "---) ° t DEC Z 7 2004 __' • i 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 #: BLD04-00818 Received Date 12/27/2004 SITE ADDRESS: 80 SPARROW LN Issue Date 12/27/2004 PORT LUDLOW, 98365 APPLICANT: ROBERT THURSTON PHONE: (360) 301-3535 80 SPARROW LN PORT LUDLOW WA 98365 17 SUBDIVISION: PORT LUDLOW NO. 4 Block: Lot: PARCEL NUMBER: 990500017 Section: 17 Township: 28N Range: 01 E CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2006 OWNER, PAUL SORRENTO PHONE: if different: MELISSA SORRENTO 5918 MONT BLANC PL NW ISSAQUAH WA 98027-7859 PROJECT DESCRIPTION: A/G 120 PROPANE TANK, GAS PIPING 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 12/27/2005. REQUIRED INSPECTIONS: Tank/Line/Appliance: 44,te D,CK hici/iweer /i/4/G, FinalApproval: /I l41/044.; 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. yrill4464, ii.gSa c JEFFERSOPSOUNTY ' IT ii ,� DEPARTMENT OF COMMUNITY DEVELOPMENT ,/ 5tJ1 -621SheridanStreet • PortTownsend •Washngton 98368360/379-4450 • 360/379-4451 Fax ! wA 4 ;!l , i �q O� www.co.jefferson.wa.us/commdevelopment rr, L �37N p i i j Master Permit Application MLA: Project Description(include separate sheets as necessary): pitoya et-'-c_ �6,-.,-/� 4 IV-,., I,: :- Tax Parcel r t- Property Number: U J°0 0 I ` t Size: (acres/square feet) Site Address and/or Directions to Property: 'C' Sp rr ru(-) C-:4 , P dr; L1.4.r0 t...p L.--) Property Owner(s)of Record: 8 c,b I -is-to r) Telephone: fi(i I 3: 3 j Fax: email: Mailing Address: S c_re_ Applicant/Agent(if different from owner): Ste. ,S kA- ,, i ,L-.2=) c—,-.-_,-__ Telephone: 3 P.) 5 -J 7 5 I Mailing Address: ) Fax: email: C) t�i,„� 0( , (� T t1 -e / C.t.)d_ I What kind of Permit?(Check each box that applies) ❑ Building I f • IJJ ( 7-Variance(Minor,Major or Reasonable Economic Use) O Demolition Permit I i V Is._ 14 V !V-4 conditional Use[C(a), C(d),or C]*" ❑ Single Family ` -' I Discretionary"D"or Unnamed Use Classification ❑ Garage Attached/Detached i 'Eb Special Use(Essential Public Facilities)** ❑ Manufactured Home ',, Oft 2 7 am undary Line Adjustment ❑ Modular E Short Plat** ❑ Commercial* t0 Binding Site Plan** ❑ Change of Use ;: r''_P''.n i ^,..:MTV ❑ Long Plat** ❑Address ❑ Road Approach :Wpf7 Planned Rural Residential Development(PRRD)/Amendments** j 'Propane ❑ Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions** 0 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 to act as my agent in matters relating to this appl' lion or permit(s). ts- OWNER SIGNATURE -,, _ Date: / /T O, 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 agre to rovide access and right of entry Jefferson County and its employees,representatives or agents for the sole purpose of application review and a y quired ter ins • lid right of entry to this property shall es a and shall occur only during regular business a hours. ' Signature: -Z_�/ Date: 1 )C_ 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 be 'ssued 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 `y u are in compliant- ' 'i 1 - - :rson County development code.The Applicant acknowledges that he,she or' holds individual �` and non-tranleta le respons'bili�adhe; g t. -nd complying with the ESA. The Applicant has read this diis ime and sign and_Oates it below. Signature: „ Date: T c/.�� / G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc ) . I OWNER BUILDER STATEMENT • The signer of this statement does hereby certify t 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 MANUFA TURED HOME INSTALLER: PHONE: FAX: C- ...) E_ . -�-)70r‘-V' ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New 0 Wood Existing: ❑ Sewer ❑ Addition 0 Steel Proposed: Bank I:] Community System O Alteration/Remodel ❑ Concrete Total: Height: Li Individual System ❑ Repair ❑ Masonry -- SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: [I Private well ❑ Two Party Type of Heat: Proposed: 0 Public Total: Name of System: If this is a Commercial Project you must answer the following: Number of Parking Spaces: Current: Proposed: y► k '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: I J Underground Tank ,Above ground Tank Size of Propane Tank: 12 6 '3 i i Heat Stove ❑ Cook Stove ❑ Woodstove ❑ Fireplace Insert Li Hot Water Tank ❑ Pellet Stove ,k Other 5?-2- p t1'u 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. Square Footage For Office Use Only Current Proposed Amount Main Floor Consistency Review: P 2NU Floor Base fee: ' 4 \ r . ,i, , \\ t a'Floor Additional Section: Mezzanine: Plan Check fee: Heated Basement State Surcharge fee: Unheated Basement Pot Water Review fee: Other Unheated 911/Rd Approach fee: Garage/Carport TOTAL: $ /7 c • Ci Decks - Receipt Number: 66 1 Other V ►} Cash/Check Number: ESTIMATED COST(REQUIRED) i 1 ' Date: i ) •Fair market value of all labor and materials foundation to finish 1 a �/� /1 ltl'"+ Initials: yl-FFRchm CntlA+?Y ^ c� +T G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.