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Home My WebLink AboutBLD2005-00191 1RUILDING PERMIT APPLICAN BLDOe 00191 Type: • Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD05-00191 Received Date: 3/30/2005 SITE ADDRESS: 111 WARBLER LN PORT LUDLOW, 98365 OWNER: ROBERT N THURSTON PHONE: (360) 437-9407 VICTORIA L THURSTON 111 WARBLER LN PORT LUDLOW WA 98365-8703 SUBDIVISION: PORT LUDLOW NO. 4 Block: Lot: 54 PARCEL NUMBER: 990500054 Section: 8 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 DESCRIPTIOP 120 GAL A/G PROPANE TANK SWAPOUT 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: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date': Type Amount Paid Bv: Date: Receipt: Approved/Date Propane Tanks/Stoves $49.00 KAS 03/30/05 71746 Total: $49.00 • • PROPANE/PELLET/WOOD STOVE & TANK INSTALLATION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD05-00191 Received Date 3/30/2005 SITE ADDRESS: 111 WARBLER LN Issue Date 3/30/2005 PORT LUDLOW, 98365 APPLICANT: SUNSHINE PROPANE PHONE: (360) 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 54 SUBDIVISION: PORT LUDLOW NO. 4 Block: Lot: PARCEL NUMBER: 990500054 Section: 8 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, ROBERT N THURSTON PHONE: (360)437-9407 if different: VICTORIA L THURSTON 111 WARBLER LN • PORT LUDLOW WA 98365-8703 PROJECT DESCRIPTION: 120 GAL A/G PROPANE TANK SWAPOUT 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 03/30/2006. REQUIRED INSPECTIONS: • Tank/Line/Appliance: eotriGf0 �s 0114Iva() .04 OA, FinalApproval: -4 r '1 J 4' '.5 GS 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£ •SITE VISIT REPORT • (PLOT PLAN) JOB `/I IDS V r -/ DATE : e j 2Z/c' -5-` . ' / / - I CONTACT: ADDRESS / W �/ P3L i2- L A/ PHONE #: . DIRECTIONS P% Ljzro FAX #: . Email . PLANNER: . i V,j ft-I- L ti, Y \:(-)1Acol cAJG 5-P.,,,Xilia.v-Eif 6-1 , . . / /./(--f ,Q, et JEFFERSON COUNTY DCD �rot, JEFFERSOIPOUNTY • a t t VDEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend •Washington 98368 ',0,,' `360/379-44501 • 360/379 4451 Fax a * !!!fJ � O www.co.effersonwaus/commdevelo g pment � ` SH?NG' - Master Permit Application MLA: JEFFERSON COUNTY D Project Description(include separate sheets as necessary): 1' f ( .7 c, 6,9 Tax Parcel �, _c/ Property Number: � ) 6 5 U v c>-i Size: (acres/square feet) Site Address and/or Directions to Property: /// (J(-1-h-6 ,- L n _ K i y-Ptio z jy..) 7dy&j Property Owner(s)of Record: /I le, 77 --J *,1 Telephone: ? -7 > 7 Fax: email: Mailing Address: _5-7 > Applicant/Agent(if different from owner): _ ,-7,....--,--,— f!,�w.,��__..,J Telephone: 3 S 5 7` 7 Fax: _ email: IMailing Address: / U� j ') �c`,� �: ` ; P/ -.0 ` What kind of Permit?(Check each box that applies) C1 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 11 Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments*" JPropane ❑ Plat Vacation/Alteration** ❑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 I *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 her by deli ate to act as ent in ma s relating to this application for permit(s). 0 IGNATURE Date: - By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is trim 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 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 equired later inspections.Access and right of entry to this property shall be requested and shall occ r only during regular business hours. Signature: Date: _2 v S 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 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-transfe able res o sihilityforadhering to and complying with the ESA. The Applicant has read this disc imer d si9ns and dates it below. Signature: Date: G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc 735°, . 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 CO RACTOR OR MANUFACTURED HOLE INSTALLER: PHONE: FAX: � a' 1� �� %�1 , /�— d ) s S 71 7 ( ) MAILING ADDRESS: / =S 1 -,e=-7 EMAIL: CONTRACTOR'S LICENSE f / NUMBER: �� `>- J/ / - NUMBER 9Lf17 J7f P X 67 7 c) PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: ❑ 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: [1 Private well ❑ Two Party Type of Heat: Proposed: LI Public Total: Name of System: If this is a Commercial Protect 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: [1 Underground Tank Above ground Tank Size of Propane Tank: /-) ! ', I i Heat Stove ❑ C k Stove ❑ Woodstove [i Fireplace Insert i I Hot Water Tank Li Pellet Stove ❑ Other 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 subm►L 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: c ' 2ND Floor Base fee: - IT pr\rk 46-1, m 3f0 Floor Additional Section: Mezzanine: Plan Check fee: _ _ Heated Basement - ° State Surcharge fee: l Unheated Basement 1 Pot Water Review fee: Other Unheated i VAR 3 0 7'15 911/Rd Approach fee: Garage/Carport TOTAL: $ Decks Receipt Number: 1) ! 1 (r, Other Cash/Check Number: i /j ESTIMATED COST(REQUIRED) Date: { / �D •Fair market value of all labor and materials foundation to finish Initials: C ), G:\PemutCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc