HomeMy WebLinkAboutBLD2005-00068 •
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 #: BLD05-00068 Received Date 2,4/2005
SITE ADDRESS: 173 NICHOLSMITH LN Issue Date 2/7/2005
BRINNON, 98320
APPLICANT: RICHARD WHITE PHONE: (360) 887-4988
JEANNINE C WHITE
21220 NW 31ST AVE
RIDGEFIELD WA 98642-8523 T 33
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 602231009 Section: 23 Township: 26N Range: 02W
CONTRACTOR: OWNER/BUILDER PHONE:
OWNER, RICHARD WHITE PHONE: (360) 887-4988
if different: JEANNINE C WHITE
21220 NW 31ST AVE
RIDGEFIELD WA 98642-8523
(360) 887-4114
PROJECT DESCRIPTION: U/G 500 GAL PROPANE TANK, H�E,WOODSTOVEJIDS-
INKCEW-TANIK
CLOTHES DRYER AND 2 RANGES AND 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 02/07/2006.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: I 4JK 3!,1mn- /4*-6/y/Or
FinalApproval:ilOOOSTO�s'L
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.c
GILDING PERMIT APPLICA BL[)05-00068
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD05-00068 Received Date: 2/4/2005
SITE ADDRESS: 173 NICHOLSMITH LN
BRINNON, 98320
OWNER: RICHARD WHITE PHONE: (360) 887-4988
JEANNINE C WHITE
21220 NW 31ST AVE
RIDGEFIELD WA 98642-8523
SUBDIVISION: Block: Lot: T 33
PARCEL NUMBER: 602231009 Section: 23 Township: 26 N Range: 02 1N
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION U/G 500 GAL PROPANE TANK, HEAT STOVE, WOODSTOVE, HOT
WATER TANK
CLOTHES DRYER AND 2 RANGES AND GAS PIPING
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:
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 $49.00 KAS 02/04/05 71377
Total: $49.00
01/31/2005 16:07 3603794451 JEFF CO DCD PAI. 04
PLOT PLAN:
A' '"' Richard & Jeannine White
Sec. 23, TWP. 26, R--2W Tay.
Surv. Vol. 10 - PG PG. 113w
Parcel * 602 231 009
Scale 1" = 100'
411
onJrry t""d
pre kok
• weLi. xr
1e
rawxi m '
•
_lnn
a� [ s,. Df.4rr111
24v C a/SErft•VIVie
CNA ,ar4 ,
/
/
R ltlee (
rrttrr
d4Aia[f/ t 1.�'M�49#
741,K /s 4#/' -r, in / �� cr/#0•110,- ,
�� v 74- 1.k i �or#X. 6D ' ha'tf% 07t E'
,f filr17/W "r/ p ),
01/31/2005 1E:07 3603794451 JEFF CO DCD PAGE i•t
24 % JEFFERSSIPCOUNTY
if erill.IM DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street•Port Townsend•Washington 98368
360/379-4450. 360/379-4451 Fax
0 www.co,)efTerscm.wa.us/commdevelopment
aster Permit Application MLA:
Prejaet Deaarlptian p►elude separate ttNoota i20 n00000ay):
1I4V
Tax Parcel Number: 6'19L 2 3/ 'le / Size:Property
ne: S 4.rres. (acres/square feet)
Site Address and/or Directions to Property: /7.f //Y1C/�DdS'Mlf.� lain,! .&ivi„an, G✓i1 f/'32 P
Propertyt3itrnler(s)of Record: A c ,-J /', ,,,,/ JL'%r Atli;II P C . krlh,l-e
Toleplwne:..JA JIV 7:-....f.Pep.. Fax: .i 1 D F/7- 9//'Y email: i'ivX/i4e.t.ej•lei snap.»
Mailing Address: Z/Z 2-p Whir): J4ciL "Five . ���i e%l� Lt 9�'6y'L
Applicant/Agent sntdAgent(If different from owner):
T8lepttane: Faun omo I:
Mailing Address. _
What kind of Permit?(Check each box that applies)
0 Building O variance(Minor,Major or Reasonable Economic Use)
0 Demolition Permit Li Conditional Use Pia).C(d),or Ci""
O Single FernUy ❑Discretionary•D•or Unnamed Use Classification
0 Garage Attached/Detached C Special Use(Essential Public Fat—Ries)"
O Manufactured Home ❑boundary Line Adjustment
❑Modular C Short Plat"
0 eommerctsi" o priding Site Plan
0 change of Use 0 Long Plat"
C Rnart onerrnawJi - lanner Rum!Rr 1IIIftiel Devadnnment(PRRi1VArrwn '"rtrinnts
0 P
Z;Yes"Use Consistency Analysis 0 Shoretne Master Program Exemption/Penh Revisions"
u 5tormttrater Management C SI'Ls elk ic Mao ut* snalit 8u4alee ALA eitsveivpnirld"
0 Site Plan Approval Advance Determination(SPAAD)" 0 Shoreline Management Variance
0 Tentlwery I1sr n nraTirrnivirinivrt Planll Inoi anti I Iran fli.itrirt Mein Amendment
o Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment
0 Forest Practices Aot/Re ease of Six-Year Moratorium
a Pro dent Conference "itiNtgirS3S a ProAvilcovan Conference
Please Identff any other local,state or federal permits riouired for this proposal,if known:
1. ,
DESIGNATION OF AGENT — —
I WO/&ski st6 to act as my agent in matters relating to this application for panfti(s).
0wnen 6 chemists Data;
By signing this application form,the uvner/spent attests that the information pinvir1M Wain,and in any attrw,nMts,In bun and nomad in the basil of
his,hot or Ira knowtodeo. Any material faloahood or any crnioolon of a motorial fast made by the cunriagont with r'oopeut to thin appliooiion packet
may result In this pamk being null and void.
I further agree to save.indemnify and hold hang Jefferson County against ell llabWllee.Judgments.court costs.reasonable attomey s fees and
tacpenses which may in any way accrue against Jefferson County as a result of twin consequence of the granting or this permit.
I?tether agree to provide access and right of entry to.teltlsrson County and Its employees.representatives or agents for the sole purpose of applicator+
raviaw owl any reetiifrelf lefer Inarrr+f4wa Altman marl Adht ni mniry M OVA rynparty shall ha racy waded anti 01a11 rvrjM
7ilIY. ._ mho A+mina roprefar tWi+3naaa
pnature._ , sari-.-r//t• ,644 e Date: C7.12— el - ei- --
The idiom or scams Applicant will undertake as a result at the issuance of this permit may negatively Impact upon one or more threatened or
endangered species and could lead to a potential"tale of an endangered species as those terms are defined in the federal law known as the
"Endangered Species Acr or'ESA.'Jefferson County makes no assurances to the epplicent that the actions that will be undertaken because this
permit has been issued will not vloiats the ESA Any individual.group or agency Carl Me a IaMuO on behalf of an endangered species regarding your
(a)won If you Bare In complier.oc with etc 3elfcrvon County dovoloprncnt*ado.Thu Applicant auknowkcdeoa that he,ahe or It holds individual
i.J.wwri.ai.areretderwtwewlL.IBejrunsalmi.kyy pJrwwrlpiylny With eft Con, 11.c. jalllachires �l.a. ViiiJia..lan..c.a.wiely a.wniJalw b itt n lv .
gnalre; /f,4,., �, / ram' Date; C�2- Z/7- E'-S
CrVP"RautC.rmcac1?ORMSW1R]P FORM51.14ester Permit t plic*don 7-&-C'4.doc __ -
01/31/2005 16:07 3603794451 JEFF CU LIL..:) PAGE 03
OWNER BUILDER STATEMENT 3 •
The signer of this statement dose hereby celty at they ere the emus of the pared ieferenceri herein.that they are want licensed contraors and swat
they,AM be assuming the reeponsbety of tha Genova ContreotOr or the proposed pmiect.
Signature: 4sl4.417 /e• /44I-sie Dale: 1%2- ei-
,...____---.
GENERAL OctrrRAcroR OR MANUFACTURED HONE INSTALLER: --PHONE: FAX: --
( ) ( )
- -
m_A__FuNG ADDRess: _emic
..-
OottrnAcTOR'S LICENSE WINS -1
Numem WADER
ARCHrTECTIENOINEER: PHONE ( ) FM:( )
INAIL1140 AO0FtESS! EMAIL
Project -- Frame Type: Bathrooms; Shoreline: Tepe of Sewage Disposal: 7
O New 0 Wood Eadsitng: _ 0 Sewer
Cl Addition 0 Steel Proposed: Batik 0 Community System
3 AlterationNernodel 0 Concrete Total: .Height: 6 individual System
O ileiSeir 0 Masonry SEP Permit$
O Demoitizin 0 Other. Berkooms: Water Supply:
Existing: Setback:
- a Private wet C Tio Party
Type of Hut Proposed: - 0 Public
Total: Nome of System:
__ 1.
p Mill Is e COmMerChiProisKi_vouNitelt answer the tollowlno:
Number at Paridng Spaces: Currwtt: Proposed; Number of 6P_A Perking Spaces:
Number of OcCupeolte(includes owners,tenants,employees.etc) Consent Proposed
' • ' YALU&
on oir8AnoIC T lance liars derma_mirk all item below Met
-
%Undenyound Tank C Above ground Tank Size ol Propane Tonic
fi(Heat Stove 0 Cook Steve A.Woodstove 0 Fireplace insert it Hot Water Tan 0 Pellet Stove it Other clitAels a/76-
la this atmlimpos belnalnlladlitillatudiclured/Mobil,HOMO? Yri I N9 ,(7.ei/ryes e 21
When appij4ng t o r a peen*to Install a propane tank you mast also submit*WS plan showing•I I of the Du/Wings,a property
lines,tank location and size,distances from Vs propane lank to al property fines.buildings and septic system components,
including the Reserve area.
4•.. •• • -,:';'''''' •'''''!'7'''''" ..',," '''.'i.!':,"7.`1.5,',:''',Iin.91' '''kl7Y,•:,'IN-., ,.,.,iif il,,,.;,',„_,,' '...41X,;,'„(
currant ;•mrsitirlAt !,,k,:::ti,',..k.o,,; (;V:,‘,I,..6,•:?‘,,,o,)..,•'',.‘,',0,t.""•:,,.A' i.',,,4„'•',,._',,,-t.S.s.,-.2.:1,1,1:,',..:::';;4;0.;':,:e:,,:,-,,I..-,P.,''`.,;k•Ati.4',"grk,-.7:.1.,
, at ?t,,:. :14(,,nti+)11,, a;;.,-i-:....7-•-..1 .4,, ,„:MS7717"', ex., , ,,,.,,: ,4f,.':•::' ,71.
.Mein Floor ,1„..; ).:1!.• +d,•.,'i. • ,,,,,,,., •i „:, ,, ,A,..,,,,,,VA„,t,"4,1.:4•#-w•;„:::;',.,;•.. 'fi,t f,
I 1,•:''•. ':' , '."':;, , F.••-;:,'''''''',''',:,:''".''I,''.''•)"'',,.!.;..' j.'.j,.7,:;:•';:'::4. ,. ,, %‘-7,:•••1';.4,.E;1-.•.-.7':..'1'rl;''''6?.%°L7i',4.:'-i47"..f:P"ltrAil..'i,'ili„., ',:‘,i:... s4s".1)A , xi
2 7 ; r.; i ;
• •,:.;•••' .1%'..•411t: ''1.',7%.,..,#`.:,,,,"it,t,IN:.--• ''"?,':,j
-:,..6- .. • .. ,,,, L •., ,,, jar.1,13?. . i, lifk4f4 c
4:71k::'.:.'C'''S'ek,,' . ''•':' ".'''''':iiii,4444'.i.f4•':'.:+'..:'...'14**.iii,,4*,.07. 5...A0H4 ,,;:.;41:RI).ik..1.4"tilp:4;
6• ':C'7.''4,:'...1.'''''r.''_,,.,.:::?,':.: , +:;• ,: r:,7,.;....:V.':('.:4;iiVti.lii.,9,..."1:‘%::'71% To: 7,,, , . -,,, ..e-,c,
,.. 14:0,. . ,. , , ,(1001444,4,17,04,t4.039 . t6f4. ,,,.... „.k140.-, , ....••-r-k ,4,,i,.• - •
0.4.,....0.
A ,,,,,,,, ,i,. ,„‘,,.„. ,. , ,, ,,,,,,,,„. ,.. ,.,..r. .,..A , ge, ,,,i , . iforoi.
.r,: .. .. .:.,.1, .- - , ... ,..',.: ....4./;i ,,, ,......„ ,., i i.l..k" , .4,k •ii‘k." - >.- '4,'i.
likliEllil i*: 0,f.; * •'',''' '!' • - '' ' t'-.-, , ;‘:• -,4N-S.,•74',4,"'• 4:, "4, '. st.'i•$$*-0,. Vti:f 4•t';'n
;,',..,:',.,.,:., •A''','.'. ! . '','-x'`7..,•::'',' ; ‘''•.' ,...;!..,''••••••-:,i.,.,:•.':, ..0:•';',$ "4..t -. ..a*i.ti„, ".al?t,,,4c,„,••
v.:F•;•7;t47):,-:ik,:r.••j'', '.VP* 11,4,'7:7.•-•r...,'-' .*,•,,,,,. ,T'.•: '1,.,.-5,-;7.wo, ., 46...ssiitf,-4:t. ,. ..-1r,T,
.i.•:•,:'",'...:'',; ••:!.....':'.,-..0':L•., •,,-. . .:`,...-•::.'5'.."P*: .-.L' 4('.'P•,:'4".•,•,•;.t.',OftL,k,i'',!', ..116,v4:4:4-$Pic.?•44'?1,;0••
Wen Ullaitscilles.1 :1,,,,': t :1,,k .' "11:.'1'-''.1"7";:"'f:7:-`,-17:4` ' .„...d,...,.*4,1*-7Z,11:7114rflti'Wri4W,
...;..f,...;. ,,ir,,,.,;.‘,ix_I-, ,e, =.,.4.:4,.ri..,.....;.1 ,,,,,:ti 1 i!....,::_,,- c,, s., 11.,
Garage/carport ,.....:•:;: ;,:.,:::•;y..t.:::,,,:t:v•,, ••,- :••,;.:.:.•; ipk*.i01.•y:•-i.,5‘.!,4`.$',0';',1. -4 ",•.':`,.;,'''C,70:,,.:)''''';'-‘'''''''
'• '• ' . ''! :. • • _ ,•.:"';.;•':,..'A%.•:,,,,:,t,,„,.• ''!•,,,Aiill•;',.'•'-.....v,,,,-)',. "vg,....,-. 1,40,2. :', 1
.1,,,,,.,..s-,....1(:,',, ,,,,4.. ,.,-i.o. .-eti-'t,',,r vt. cpc,,,,, ,,*:,..,A..0.5n.,e4tif.,„ i• i‘, 4 F1:07:-•••1,1‘'i' t':":7.?r.
07.V, .. ..',".•'::0C''. ,,.'"!:.',ti'•14000110 ' ' ' .*-'.,,,,fr4,0,..,i;''' I Rk.,*1,k,';:if.,,;:?:1:-:'''5,1`;4, '''''...' io,i,„',, ` _46,10: ri i 2\001
Other , , - , , i . ^• ' 1,,/,w.a.v-1', ,.6. ,i,,,. .,, ''-•'th3/42„,,, ,i,!* .•. r Al',-6.7.4flit'4 1%'-) /
• ' 4.-:•. ' ..', . ''Y . , .', ',S.,4,3 ,',..,,41A•!,',gli,,'",..'" 'AVIA...r107'031Woftt,"eVr•,,,,,+f-S1 ,,s.7.i.,1,f,,,14,,,. 50 1,-1
ESTlikUk P ' LAM 111'ECKNKCUI .V0t10.:!,'....'..,t.',:: 7:w.;1,...T.!;'t 5.i X:'f51,:• ;'-,t!.;''''11,„ ,i'-...''"' , i.:..'7'4'.." iraC._
veers of a N labor end materiels founderion to finish ,t-.. :;‘;::;::,•;,...,i,-;.;:. :,;. 'L'':,: ',,yi,5;,„,,‘;;;.:%Air prcii L, •;:' ',.- i.L IA'. , -": - i u....)-&:... ,,Igi,.. •••.:,::.-,.„,.,...,:.:„.r. ••• ,)1.a„Ak.v.,f .. ,.,-.- ,2-,,,k,,,11,,,N ,,ir:vir 1 . '7.:cAvd.,,
'1! '. k•. :H. '..'(:'':',. C.:.,k.'sinvii st,:p4,-..: ,q);,.;,,,' x••w,,,,,,, ',-: 7 :::14,','i.r:.4
.' . •.. , '..''' l'').°:.1' ;*.i2.V,...r;•=1-;,1•'''.':1::7' '-`,V.,,;\.,.-''::'--Vic ' -..'i:9'..s..•4•"r.' '
-----
GAperrnoCeiner%FORMS\DRD POILMSVAsstcr Ptanit Appriciiion 7-8-044oc
-4-.