HomeMy WebLinkAboutBLD2005-00206 • •
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 #: BLD05-00206 Received Date 4/6/2005
SITE ADDRESS: 830 CENTER RD Issue Date 4/6/2005
CHIMACUM, 98325
APPLICANT: RUSSELL E LAASE PHONE: (360) 732-4446
CAROL A LAASE
830 CENTER RD
CHIMACUM WA 98325-9710 T 68+
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 901143005 Section: 14 Township: 29N Range: 01W
CONTRACTOR: EVERWARM INC PHONE: (360)452-3366
257151 HWY 101
PORT ANGELES WA 98362
Contractor's License EVERWI*088NL Expires 08/17/2006
OWNER, RUSSELL E LAASE PHONE: (360) 732-4446
if different: CAROL A LAASE
830 CENTER RD
CHIMACUM WA 98325-9710
PROJECT DESCRIPTION: REPLACE FREE STANDING WOODSTOVE WITH PELLET STOVE
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 04/06/2006.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: rFL[.FT 6-r2%J jL rALI.-A1'n',) (71( ,ii6
AC //79/
n '
FinalApproval: .cc ' = wiz), S
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
BLD05-00206
ItILDING PERMIT APPLICATIN Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD05-00206 Received Date: 4/6/2005
SITE ADDRESS: 830 CENTER RD
CHIMACUM, 98325
OWNER: RUSSELL E LAASE PHONE: (360) 732-4446
CAROL A LAASE
830 CENTER RD
CHIMACUM WA 98325-9710
SUBDIVISION: Block: Lot: T 68+
PARCEL NUMBER: 901143005 Section: 14 Township: 29 N Range: 01 W
CONTRACTOR: EVERWARM INC PHONE: (360) 452-3366
257151 HWY 101
PORT ANGELES WA 98362
Contractor's License EVERWI*088NL Expires 08/17/2006
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION REPLACE FREE STANDING WOODSTOVE WITH PELLET STOVE
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:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total: Total:
Routing Date:
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $49.00 KAS 04/06/05 71856
Total: $49.00
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orr cO JEFFERSONDUNTY [�
l \ 1,4.a DEPARTMENT OF COMMUNITY DEVELOPMENT •
621 Sheridan Street • Port Townsend •Washington 9836.8.
360/379-4450 • 360/379-4451 Fax -1'
�q � www.co.jefferson.wa.us/commdevelopment
`S`HING`S ! twit _ 6 2005
Master Permit Application MLA:
Pro'ect Description(include separate sheets as necessary):
p/ e- J-1,-ef„4 01,5 - w , fief/e � •, -
Tax Parcel Property -/-
Number: �a t / ' - 6 0-A / Size: / y — t° s (acres/square feet)
Site Address and/or Directions operty: E . (�„ („i /?cX C A a c u, k
Property Owner(s)of Record: S C 6- �l z a✓d ,,./ A- . .�/4 14 S
Telephone: 0 - 7 3 L - VY(0 ax: am email:ni vet- 4t_ o/y p e., ,c,or+
Mailing Address: 3 o Ce c-! /6.k C w�.a c K►,, I.tJ j/� f
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies)
ti Building n Variance(Minor,Major or Reasonable Economic Use)
❑ Demolition Permit Li 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 I 1 Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments**
❑ Propane ❑ 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
*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 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 arty requir later inspections.Access and right of entry to this property shall be requested and shall occur only during regular business
hours. 7 1
Signature: ���r'G' � Date: 7•7f7 / , )1.312
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 re in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transferable esponsibili fora Hering to and complying with the ESA. The Applicant has read this aimer and Signs and dates it below.
Signature: Date: ! y) /
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc