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Home My WebLink AboutBLD2004-00024 41 • 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 #: BLD05-00024 Received Date 1/11/2005 SITE ADDRESS: 152 CLEVELAND ST Issue Date 1/13/2005 PORT HADLOCK, 98339 APPLICANT: RICHARD E GIGER PHONE: (425) 503-6374 JANET M GIGER 921 1ST AVE W APT 106 SEATTLE WA 98119-3702 T 21 SUBDIVISION: IRONDALE AC TRACTS Block: Lot: PARCEL NUMBER: 962700098 Section: 7 Township: 29N Ranpe: 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, RICHARD E GIGER PHONE: (425) 503-6374 if different: JANET M GIGER 921 1ST AVE W APT 106 SEATTLE WA 98119-3702 PROJECT DESCRIPTION: GAS INSERT 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 01/13/2006. REQUIRED INSPECTIONS: Tank/Line/Appliance: RFnteo Zoe L,z,gr j' /i rActsD - ' pie /N6t r `./Yle)S1/74 FinalApproval: O,(/ Cr }ir%al /05- BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTION 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. •UILDING PERMIT APPLICAN BLRDOe 00024 Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD05-00024 Received Date: 1/11/2005 SITE ADDRESS: 152 CLEVELAND ST PORT HADLOCK, 98339 OWNER: RICHARD E GIGER PHONE: (425) 503-6374 JANET M GIGER 921 1ST AVE W APT 106 SEATTLE WA 98119-3702 SUBDIVISION: IRON DALE AC TRACTS Block: Lot: T 21 PARCEL NUMBER: 962700098 Section: 7 Township: 29 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 DESCRIPTION GAS INSERT 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 01/11/05 69049 Total: $48.00 Jan 10 05 10: 58a North•Bend Elementary Sch 4258318410 p. 3 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 CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ( ) ( ) MAILING ADDRESS: EMAIL CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type ❑ New ID Wood Existing: of Sewage Disposal: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System 0 Alteration/Remodel ❑ Concrete Total: Height: 0 Individual System ❑ Repair ---.--.0-Masonry SFP Permit# C Demolition o Other Bedrooms: Water Supply: Existing: Setback: ❑ Private well 0 Two Party Type of Heat: Proposed: O 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: Li Underground Tank o Above ground Tank Size of Propane Tank: 0 Heat Stove 0 Cook Stove 0 Woodstove Fireplace Insert 0 Hot Water Tank 0 Pellet Stove D Other is this appliance being installed In a Manufactured I Mobile Home? Yes /CO 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 ., } 4 Current Proposed lmouns� 3 k Main Floor : �. . Consistency �, ry !�.'�1�,Mr � ; 2 Floor (3 ase fee �' z sa. r h5 .• .-=��r _ fi�tt'/ c' q � Ifs;� _-...... .Additonai Section, = : Mezzanine: Plan Check fee: Heated Basement StateSurch arge fee;, ' v Unheated Basement ales Reviawfee _ t / w.Y a Pot_W 4 Other Unheated 911/Rd Approach fee a + Garage/Carport TOTAL << C)0 . Decks i „ . ti Receipt Number Other Cash/Chock Numbs :':_f...':,::::' '"1:-.-,s7:;,,,7:'.;:;.,!,::1„;,:.::,:i: "'•?'-7t.'il- 7!q,.-: ESTIMATED COST(REQUIRED) Data: 444!. x 'r ,`i"��7` y .Fair market value of all labor and materials foundation to finish 'I••_ Initials: • r Ce` SOT T tVb 1 G:\PermitC:entcr\FORMS\DRD FORMS\Master Permit Application 7-S-04.doc I Jan 10 05 11 : 03a North Bend Elementary Sch 4258318410 p. 2 • i • • ' K-S-5-16N L 0 JEFFERSON COUNTY a' ' . 'A DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend•Washington 98368 360/379-4450 • 360/379-4451 Fax 0 www.co.jefferson.wa.us/commdevelopment 1`ZiiING' Master Permit Application MLA: Project Description(include separate sheets as necessary): G.As 4.0 s e.c..T- Tax Parcel /� "7 0 0 ( y 8 Property Number: "( ( Size: (acres/square feet) Site Address and/or Directions to Property: 15 a:- G) e Je 1G"'`'S Sfi . P I . 1-firt)Lo c4c Property Owner(s)of Record: Q.\ 1+ -P- O s `J 0^R.I M tS/c-e R- Telephone: 503 -6.3 7 tt Fax: email: Mailing Address: 921 1 Sr / - W /04 Sea ttLe- , 1n/f)- 5e// ' Applicant/Agent(if different from owner): St-oil S ff/k7'e- Pro PP—A-- Telephone: 3 6O •3`8 S•5 Fax: email: Mailing Address: i 0 8 53 011)01 Or. d o-Y fff9f.3(-G c-A What kind of Permit?(Check each box that applies) Building 0 Variance(Minor,Major or Reasonable Economic Use) 0 Demolition Permit ID Conditional Use[C(a),C(d),or CI" 0 Single Family ❑ Discretionary"D"or Unnamed Use Classification ❑ Garage Attached/Detached ❑Special Use(Essential Public Facilities)" U Manufactured Home 0 Boundary Line Adjustment D Modular 0 Short Plat" D Commercial• D Binding Site Plan" n Change of Use ❑ Long Plat" 0 Address 0 Road Approach 0 Planned Rural Residential Development(PRRoWAmendments" 4'Propane 0 Plat Vacation/Alteration" O Allowed"Yes"Use Consistency Analysis Cl Shoreline Master Program Exemption/Permit Revisions" [1 Stormwater Management ID Shoreline Management Substantial Development" ❑ Site Plan Approval Advance Determination(SPAAD)• ❑ Shoreline Management Variance D Temporary Use ❑Comprehensive PlarVUDC/Land Use District Map Amendment 0 Wireless Telecommunication* D Jefferson County Shoreline Master Program Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium 'Ma titre a Pre- lication 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). y�WNER SIGNATURE Date: /" 'ito a `� ay 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 irs 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.Access and ri of entry to this property shall be requested and shall occur only during regular business 1. hours. J \ d /d 4"Ignature: n" Date: 5 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"lake"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 County development code.The Applicant acknowledges that he,she or It holds Individual and non-transferable r pe Will for ad in complying with the ESA. The Applicant has read this disclairper a signs and dates it below. `Signature: Date: 7 'S G:\p nitantcr\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc S007, i l Ndf if(,, P U