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Home My WebLink AboutBLD2005-00444 • • 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 #: BLD05-00444 Received Date 7/7/2005 SITE ADDRESS: 377 REUBEN JOHNSON RD Issue Date 7/8/2005 PORT LUDLOW, 98365 APPLICANT: MARK A HITCH MARGARET G HITCH PHONE: PO BOX 65454 PORT LUDLOW WA 98365 SUBDIVISION: FOREST HILL SHORT PLAT 4 Block: Lot: PARCEL NUMBER: 821082022 Section: 8 Township: 28N Range: 01 E CONTRACTOR: C H S PHONE: PO BOX 518 (360)732-4585 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/7/2006 OWNER, MARK A HITCH PHONE: if different: MARGARET G HITCH PO BOX 65454 PORT LUDLOW WA 98365 PROJECT DESCRIPTION: INSTALL 120 GALL A/G PROPANE TANK, HEATING STOVE AND COOKTOP 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 7/8/2006. REQUIRED INSPECTIONS: Tank/Line/Appliance4,JK 47ierz.eior_ ewe- vj1 7 id FinalApproval: OK 4Pr- r L 1 lZ/_ e.5 3 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 IIPUILDING PERMIT APPLICASN BLD05-00444 Jefferson County Department of Community Development Review Type: 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD05-00444 Received Date: 7/7/2005 SITE ADDRESS: 377 REUBEN JOHNSON RD PORT LUDLOW, 98365 OWNER: MARK A HITCH PHONE: MARGARET G HITCH PO BOX 65454 PORT LUDLOW WA 98365 FOREST HILL SHORT PLAT SUBDIVISION: Block: PARCEL NUMBER: 821082022 Section: 8 Township: 28 N Range: 01 E Lot: 4 CONTRACTOR: C H S PO BOX 518 PHONE: (360)732-4585 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/7/2006 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOt INSTALL 120 GALL A/G PROPANE TANK, HEATING STOVE AND COOKTOP 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: CONST TYPE: GARAGE: SHORELINE: DECK: SETBACK: SEWAGE DISPOSAL: BANK HEIGHT: 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 PRB 07/07/05 73467 A PP ROVE1Total: $49.00 JUL - 8 2005 rartmerson County Planning f ' B ent l je • l j--- P("-et y, s Li tt <.49i'E /' d. IfilligrZalLT PI:7M R.--19. CJ/-B L Lf9 C .SUZA4 177MD 73 ' d/4 l s19/0Er LJELCI-t, S. N --,---.),-----,_ m f` c�� l ' l 1 sec }at A • ( 1 I Ci -.. -------)----)[11 ",,.\\ AV Ei-L. -Di-loP , 7 , i4. et, SEE DET4'1 B —' ., . NNE, 0 ( I/taus-6 .� JUL - 7 2005 A-t\YK „ I DEC -- 2 2002 ' . ii 1 JEFFERSON COUNTY DEPT.OF COMMUNITY DEVELOPMENT Ji,r`, v.� Y Y _ DEPT. OF COMMUNITY OEVELOFMEN� LE-Colt A -DEtAl 3 G(e.bd GJr m -T-4SpectidN �o2r To TR-Enlci/ 8.02 5 9 4/AIEr3 • last. a 9M \i"lISpec u.v i tt- Tb d2i c`CE v S'' CEN7'04Z 7b W Gem teit. 41 t,i ) 0-F o� {� 5c41t -- l'- la. I .¢gON C, w' o6� JEFFERSOI•oUNTY • DEPARTMENT OF COMMUNITY DEVELOPMENT ,-' ` '"4 621 Sheridan Street • Port Townsend •Washington 98368 4, 360/379-4450 • 360/379-4451 Fax .4NG�O www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: Project Description(include separate sheets as necessary): Tax Parcel Number: Il�(J 7 Property - Size. .trA-c_w g< (acres/square feet) Site Address and/or Directions to Property: .. ,' 7 e ,, �.C�v Olfi�� i�Property Owner(s)of Record: IA r--f_ k, (c t.r H- Telephone: 4_-3'7 ') , j Fax: - Mailing Address: P 0 f. i/_ Applicant/Agent(if different from owner): Telephone: Fax: Mailing Address: email: W at kind of Permit?(Check each box that applies) Building ❑ Demolition Permit n ■..• .ance(Minor, Major or Reasonable Economic Use) CI Family V' [ i, Conditional Use[C(a),C(d),or C]** ❑Garag Single Attached/Detache. - la Discretionary"D"or Unnamed Use Classification ii Special Use(Essential Public Facilities)** 0 Manufactured Home JUL ZQ�5 CI Modular ii .Boundary P at Line Adjustment ❑Commercial* ■� prt Plat** ❑Change of Use CI Site Plan** ❑Address ❑ •o�Apf ]� ERSON COUNTY ❑ Lo g Plat** Pr pane ■ 'I.nned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis PM i " •t Vacation/Alteration** ❑ Allowed r Use st s D Shoreline Master Program Exemption/Permit Revisions** -`� "`'- -,, ° - *--0•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 0 Forest Practices Act/Release of Six-Year Moratorium *May require a Pre—Application Conference **Requires a Pre-Application Confe Please identify any other local, state or federal permits required for this proposal, if known:rence I hereby designate DESIGNATION OF AGENT 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 any required later inspections.Access and right of entry to this property shall be requested and shall occur only during regular business hours. Signature: Date: 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-transferable responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: Date: G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc 1\ 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 g responsibility proposed 1 they will be assumingthe of the General Contractor for the ro project. i PHONE: FAX: Signature: Date: iZ.<-A. -- GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: ( ) ''�'N e '` EMAIL: MAILING ADDRESS: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAx:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ) Wood Existing: ❑ Sewer ❑ Steel Proposed: Bank Ill Community System 7 Alterati ❑ Additionaion/Remodel ❑ Concrete Total: Height: ❑ Individual System SEP Permit# ❑ Repair ❑ Masonry ❑ Other: Bedrooms: Water Supply: ❑ Demolition Existing: Setback: Private well 1 Two Parry �'''"�/ r ' Proposed: I 1 Public Type of Heat: Total: Name of System: If this is a Commercial Project you must answer the following: Number of ADA Parking Spaces: Number of Parking Spaces: Current: Proposed: 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: i 1 Underground Tank NI&Above ground Tank Size of Propane Tank: !,)-C A Heat Stove X.Cook Stove L I Woodstove I I Fireplace Insert i 1 Hot Water Tank ❑ Pellet Stove [I 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 s►te 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. I ISquare Footage For Office Use Only Amount Current Proposed Main Floor Consistency Review: 7tl_tt1 2Nu Floor Base fee: J►rj_[.�1../ 3f°Floor Additional Section: �`� Mezzanine: Plan Check fee: Heated Basement State Surcharge fee: Unheated Basement Pot Water Review fee: Other Unheated 911/Rd Approach fee: Garage/Carport TOTAL: $ .,-7 J s-.0 Decks • Receipt Number: Other Cash/Check Number: a :0 ESTIMATED COST(REQUIRED) Date: `1! •Fair market value of all labor and materials foundation to finish Initials: G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc