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Home My WebLink AboutBLD2005-000171 MILDING PERMIT APPLICATA BLD0 00017 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD05-00017 Received Date: 1/10/2005 SITE ADDRESS: 490 DENNIS BLVD PORT TOWNSEND, 98368 OWNER: JACKIE E ADAMS PHONE: (360) 385-4219 490 DENNIS BLVD PORT TOWNSEND WA 98368-9412 SUBDIVISION: CAPE GEORGE VILLAGE DIV 1 Block: Lot: 13 PARCEL NUMBER: 939900014 Section: 13 Township: 30 N Range: 02 W CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTP198306 Expires 09/26/2006 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP A/G 120 GAL 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 By: Date: Receipt: Approved/Date Propane Tanks/Stoves $48.00 KAS 01/10/05 69043 Total: $48.00 • • PROPANE/PELLET/WOOD STOVE & TANK INSTALLATION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (330)379-4451 PERMIT #: BLD05-00017 Received Date 1/10/2005 SITE ADDRESS: 490 DENNIS BLVD Issue Date 1/10/2005 PORT TOWNSEND, 98368 APPLICANT: JACKIE E ADAMS PHONE: (360) 385-4219 490 DENNIS BLVD PORT TOWNSEND WA 98368-9412 13 SUBDIVISION: CAPE GEORGE VILLAGE DIV 1 Block: Lot: PARCEL NUMBER: 939900014 Section: 13 Township: 30N Range: 02W CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTPI983O6 Expires 09/26/2006 OWNER, JACKIE E ADAMS PHONE: (360) 385-4219 if different: 490 DENNIS BLVD PORT TOWNSEND WA 98368-9412 PROJECT DESCRIPTION: A/G 120 GAL PROPANE TANK, GAS PIPING THIS PERMIT IS VALID FOR ONE YEAR AND IS NOT RENEWABLE. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 01/10/2006. REQUIRED INSPECTIONS: a .Tank/Line/Appliance: FinalApproval:// 1 —17 JD$ 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 10/29/19c 1,, oN C06. g ! NI EFFERSONUNTY ;° �.. r HI/ �-1 H 114,z TY! E r (..' T • E 621 Sheridan Street • Port Townsend Washington 98368 i I 360/379-4450 • 360/379-4451 Fax , O i �qp� www.co.jeffersonwaus/commdevelopment Master Permit Application MLA: Project pe cription Inclurrde separate_sheets 7essarY /' f' Tax Parcel (— Property Number: 1'3' C U 0 C0 1 4 Size: (acres/square feet) Site Address and/or Directions to Pro rty: `']' motif N( VL1)C) Property Owner(s)of Record: £1 c) C-7 Telephone: 3 6:75 (4 Z l Fax: email: Mailing Address: J ft ty\p Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: 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 ❑ Road Approach ❑ Planned Rural Residential Development(PRRDyAmendments>ctlfropane ❑ Plat Vacation/Alteration** LI 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 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 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,representatives or agents for the sole purpose of application review and any required later inspections. •►•-. and right of entry to this property shall be requested and shall occur only during regular business hours. / i1 Signature: �C' •/�- �`/ Date: /`��/�J 3 if The actionCr actions plicant 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)ev If u are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non- nsfe ble responsibility for izing to and complying with the ESA. The Applicant has read this discO�mmer and igns and dates it below. Signature: -_ / Ce / /l ) c�- 9 G�'" G � ��--f Date: � �U��'� � G:\Pemv rater\FORM DRD FORMS\Master Permit Application 7-8-04.doc • OWNER BUILDER STATEMENT • 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 CONTRACTORNTTfACTOR OR MANUFACTURED HO NSTALLER: PHONE: FAX: MAILING ADDRESS: 7 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 ❑ Wood Existing: CI Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: ❑ Public Total: 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 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 ,4bove ground Tank Size of Propane Tank: Ar. ,0�f�.t::^ `Heat Stove ❑ Cook Stove ❑ Woodstove 0 Fireplace Insert ❑,.•t Water Tank ❑ Pell t Stove ❑ Other /Is this appliance being installed in a Manufactured/Mobile Home? 0, No When applying for a permit to install a propane tank you must also 'mit 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: 1 _,j 2NU Floor Base fee: 3f1 Floor Additional Section: Mezzanine: Plan Check fee: Heated Basement State Surcharge fee: Unheated Basement Pot Water Review fee: u 2005 Other Unheated 911/Rd Approach fee: Garage/Carport TOTAL: $ Decks yReceipt Number: ik- : _l Other Cash/Check Number: ii ESTIMATED COST(REQUIRED) Date: •Fair market value of all labor and materials foundation to finish I 1( . Initials: G:\PennitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc U I C.) CD . Z 7 • - Dc-Y • C1 .C. 1 mod- `� • •