The URL can be used to link to this page

Home My WebLink AboutBLD2005-00385 • 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 #: BLD05-00385 Received Date 6/14/2005 SITE ADDRESS: 15 AMES LN Issue Date 6/14/2005 PORT LUDLOW, 98365 APPLICANT: JACK F EVERNDEN PHONE: 15 AMES LN PORT LUDLOW WA 983659626 1 SUBDIVISION: PORT LUDLOW NO 1 Block: Lot: PARCEL NUMBER: 990400301 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, JACK F EVERNDEN PHONE: if different: 15 AMES LN PORT LUDLOW WA 983659626 PROJECT DESCRIPTION: NO MLA REQ'D - 120 GAL A/G PROPANE TANK 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 6/14/2006. REQUIRED INSPECTIONS: Tank/Line/Appliance: a — LAO 'AIu 7s1NK.S .04 Wos FinalApproval: (7k 41. „A.I I/4/645 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_B LD_Permit_Propane.rpt 10/29/19c • • BLD05-00385 BUILDING PERMIT APPLICATION Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD05-00385 Received Date: 6/14/2005 SITE ADDRESS: 15 AMES LN PORT LUDLOW, 98365 OWNER: JACK F EVERNDEN PHONE: 15 AMES LN PORT LUDLOW WA 983659626 PORT LUDLOW NO 1 SUBDIVISION: Block: Lot: 1 PARCEL NUMBER: 990400301 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 DESCRIPTIOr NO MLA REQ'D - 120 GAL AIG PROPANE TANK 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: s Total: Routing Date:. Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $49.00 CJZ 06/13/05 73369 Total: $49.00 • SITE VISIT REPORT (PLOT PLAN) DATE : • iB CONTACT: • DDRESS PHONE #: • • ,IRECTIONS FAX #: Email • PLANNER: • O 7\ �o( S N' Sol CD *V) _ 0'%°°" I; y r�Jtfkc06 JEFFERSON COUN1 'rg ' �� DEPARTMENT OF COMMUNITY DEVELOPMENT ino ‘)' 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax DOD gS�N0�0 www.cojefferson.wa.us/commdevelopment JEFFERSON COUNTY Master Permit Application MLA: Project Description(include separate sheets as necessary): � n.90 •-•,...,___ +61-/e__ _S L,J c--to O Tax Parcel 1 el 0 �� Property Number: Size: (acres/square feet) Site Address and/or Directions to Property: 1 5/ 4772 �� 2-1 r-R-- "i - 11'1,0Lu cJ Property Owner(s)of Record: I J�-P/< 9 %�f j_a�.-. s U,'�A./ Z) A' Telephone: `f 3 7 7733 Fax: email: Mailing Address: - S C Applicant/ OM(If different from owner): vl r-1-.v _____- /4-.5-x9 - Telephone: 36,O 2B5 S 7 •T 7 Fax:--- � 75 email: Mailing Address: /O ._S— .�- /), L J What kind of Permit?(Check each box that applies) I_i Building ❑ Variance(Minor, Major or Reasonable Economic Use) u Demolition Permit ❑ Conditional Use[C(a),C(d),or C]** ❑ Single Family 0 Discretionary"D"or Unnamed Use Classification ❑ Garage Attached/Detached ❑ Special Use(Essential Public Facilities)** LI Manufactured Home ❑ Boundary Line Adjustment ❑ Modular ❑ Short Plat** Cl Commercial* ❑ Binding Site Plan** ❑ Change of Use ❑ Long Plat** X❑Address ii Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** ropane ❑ 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 AGENT I hereb designate----- act a my agent in ma ers relating to this pplication fir permit(s). Ow NATURE Date: i By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is t ue 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 o to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any required later inspections. ss and right of entry to this property shall be requested and shall occur only during regular business hours. Signature: r/t( 6 l ,,,,,„/ Date: 0 4/o 7/D The action acti s Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endange species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the "Endangers l Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has koen issu will not violate the E Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if you a in compliance with fe Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transfers responsibility f_ adh to and complying with the ESA. The Applicant has read this disclai er g s andslates it below. Signature: ((��ff G� /`l? t�-t !�/ ��j 7,p I Date: l / El G:\PemutCenter\ OiFt4S\DRD FORMS\Master Permit Application 7-8-04.doc • OVw.ER 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: GENE CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ( ) joss-75 7( ) MAILING ADDRESS: /U 8 LI":3 aj P[ EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: ci/ j x 6 7 7 Q e NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: Li New ❑ Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel 0 Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# n Demolition n Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: ❑ 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: ! Underground Tank Above ground Tank Size of Propane Tank: --f /9--0 —P . Heat Stove t] Cook Stove [1 Woodstove l 1 Fireplace Insert ❑ Hot Water Tank 0 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 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 Current Proposed Amount Main Floor Consistency Review: o?`t�50 2Nu Floor Base fee: 'Icic OV Floor — 4 Additional cocoon: Mezzanine: Plan Check fee: — Heated Basement State Surcharge fee: Unheated Basement _ Pot Water Review fee: Other Unheated 911/Rd Approach fee: Garage/Carport TOTAL: $ S° Decks Receipt Number: rj 33(e 01 Other Cash/Check Number: ,_ w ESTIMATED COST(REQUIRED) Date: •Fair market value of all labor and materials foundation to finish b 1 i .5 Initials: \1'em itCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc 5