HomeMy WebLinkAboutBLD2005-00104 0 •
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 #: BLD05-00104 Received Date 2/24/2005
SITE ADDRESS: 23 FAIRBREEZE DR Issue Date 2/25/2005
PORT TOWNSEND, 98368
APPLICANT: SUNSHINE PROPANE PHONE: (360) 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
279
SUBDIVISION: KALA POINT#5 Block: Lot:
PARCEL NUMBER: 965000162 Section: 27 Township: 30N Range: 01W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2006
OWNER, ALAN H GARDNER TRUSTEE PHONE: (360) 316-9013
if different: NICOLE M GARDNER TRUSTEE
241 SAND RD
PORT TOWNSEND WA 98368
PROJECT DESCRIPTION: GAS PIPING (ADDING TO EXISTING PIPING FOR DRYER)
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 02/25/2006.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: C-fJ(_OK S/?m.5—
•
FinalApproval: ),(.- " /Zi5"
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 10/29/19E
SUILDING PERMIT APPLICAJN BLD05-00104
Review
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD05-00104 Received Date: 2/24/2005
SITE ADDRESS: 23 FAIRBREEZE DR
PORT TOWNSEND, 98368
OWNER: ALAN H GARDNER TRUSTEE PHONE: (360) 316-9013
NICOLE M GARDNER TRUSTEE
241 SAND RD
PORT TOWNSEND WA 98368
SUBDIVISION: KALA POINT#5 Block: Lot: 279
PARCEL NUMBER: 965000162 Section: 27 Township: 30 N Range: 01 W
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 DESCRIPTIOP GAS PIPING (ADDING TO EXISTING PIPING FOR DRYER)
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION
CODE EDITION: 2003 ADD'L: HEAT TYPE:
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
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 Bv: Date: Receipt: Approved/Date
Propane Tanks/Stoves $49.00 KAS 02/24/05 71526
Total: $49.00
02/18/2005 17:29 3603794451 JEFF CO DCD PAGE 02
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Co • JEFFERSON CtUNTY r
dwl:
DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street•Port Townsend•Washi ton-I98368 _- --
�� 360/379-4450. 360/379-4451 Fax F E B 2 4 2005
www.ao.jenferson.wa.us/commdevelopment
`�TINar
Master Permit Application MLA:
•
Project Descriptionseparate sheets as necessary): -/
(include :-E-4Per:Z.Size; 42-3
; r J P //b'rc, rdrC9-!4S P 1)�� �1 Cr � "� JTax i ,c s� avv �� Z (PNumber: / oesiequare feet)
Site Address amdlor Directions to Property: =23 FAI�B
Property Owner(s)of Record: f1 LAB/ /ll Go e �-y 19 i� /� C_
Telephone: . / ,a -9'o� 3 Fac _ email:
Mailing Address: �$ �j1,0,z,,,`/
Appticantiftent differentfro�owner):____AZJA-,"--t7-1'-e--,-<---
Fax email:
Mailing Address:_� Z
What kind of Permit?(Check each box that applies) or Reasonable Economic Use)
❑Building n variance(Minor,Major
C Garage
lion Permit D Carance al Use[C(a).C(d).or CI••
Singlea Discretionary"D"or Unnamed Use Classification
O Family O Ste .(Essential Public Facilities)""
❑Garage uredHAttached I Dtereclred C Boundary Line Mluntment
e Manufactured Home O 5ttort}, +f
D Modular 0 g Site Puri
C Chengecde{" 0 Long Plat"
D Change of Use 0 Planned Rural Residential Development(RRRO)/Arnendments"
Address D Roan Approach
P `� D Plat Vacation/Alteration" Revisions"
C Allowed*Yee Use Consistency Analysts 0 Shoreline Master Program Exemption/Permit
D Stornwator Management 0 Shoreline Management Substantial Development
C Site Plan Approval Advance Determination(SPAAD)• C Shoreline Management Variance
0 Comprehensive Plan/UDCILand Use District Map Amendment
O r T Use 0 Jefferson Co+stty Shoreline Master Program Arnendrnedtt
0 Wireless TeiecoRx�ti�Iiicrt`
D Forest Practices Act/Release of Six-Year Moratorium uires s Pre-Application•May require a Pre-.sppticstlon Conference if known:
1
Please identify any other local,state or federal permits required for this proposal,
DESIGNATION OF AGENT
to aCi my in m
Da iatirig• to this eppi{cation pe it(s).
1 I3tirsre 1/
i OtnNEP SIGNATURE — -- -
r-By ovtde i herein.and In arty attacftte . ne and correct t to the best
l signing-
this application form.the pwner/agent attests that Ire information pr + '+x to{Ns � sts S
t his.hof er Or Its tlndeterfge. l try matertat tatsehooa or any omission of a materiai tact made bythe ;_ nnts li'
\ 1 may result in Iris permit being fail arta vim.
as sambas,judgments,court cost.r� y s sees arta i
I i further agree to save,indemnity and hold irarmlees Jefferson County against }
expenses MUM may in any Wray against Jetserson wont,"as a rerun or or in wtisoquti wr.n lams ix at`tary"t lilt.punit.k.
and of entry en.laicism County lino its call l e . +f :a:awes or agerxs for me sold puts or epOw;el"_ i
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02/18/2005 17:29 3603794451 JEFF CO DCD PAGE 03
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OWNER BUILDER STATEMENT
The signer of this statement does hereby�that they are the Owners of the
proposed parcel ref �herein,that they ere not licensed contractors and that
they vAl be assuming the responsibility ect
Signature: Date:
-
`GEtI CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAx:
0/1.oy) ( 30 ) 38SS1 y 7 ( )
MAILING ADDRESS: /667S3khOJAI4 /2!�{ EMAIL.
CONTRACTOR'S LICENSE �o WAINS
NUMBER: Gw, 6 7 Q P NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX( )
MAILING ADDRESS: EMAIL
FrameP Tom: Bathrooms: Shorelirte: Type of Sewage Disposal:
0 New TyPe� Wood0 D Existing: 0 Sewer
0 Addition D Steel Proposed: Bank ❑Community System
o Alteratiott/Remodel ❑ Concrete Total: Hem: ❑ Individual System
❑ Repair 0 Masonry SEP Penns#
0 Demolition 0 Other: Bedrooms: Water Supply
Existing: Setback: 0 Private well ❑ Two Party
Type of HeatProposed: i T27 Public
I
Total I _ ( Name of System:
Ii
I
If this Is a Commercial Prolect you must artswer the following: Number of ADA Perking Spaces: I
i Number of Pe tktg Spaces: Current wed:
Number of occupants Ondudes owners,tenants,employees,eM; Current Propose i
• s NlIE .1 .are t-000 rY�i � , i rip
t :BC Cxx:.:�c, rSt: :
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