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Home My WebLink AboutBLD2005-00504 ILDING PERMIT APPLICATIA BLD05-00504 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD05-00504 Received Date: 7/29/2005 SITE ADDRESS: 60 WARBLER LN PORT LUDLOW, 98365 OWNER: ALLEN A UYEDA PHONE: (360)437-7813 SHANNON L UYEDA 60 WARBLER LN PORT LUDLOW WA 98365-9554 PORT LUDLOW NO. 4 SUBDIVISION: Block: Lot: 49 PARCEL NUMBER: 990500049 Section: 8 Township: 28 N Range: 01 E CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTPI98306 Expires 09/26/2006 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION INSTALL A/G 120 GAL PROPANE TANK, GAS INSERT AND GAS PIPING 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 07/29/05 73367 Total: $49.00 V • PROPANE/PELLET/WOOD STOVE & TANK INSTALLATION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD05-00504 Received Date 7/29/2005 SITE ADDRESS: 60 WARBLER LN Issue Date 7/29/2005 PORT LUDLOW, 98365 APPLICANT: ALLEN A UYEDA PHONE: (360)437-7813 SHANNON L UYEDA 60 WARBLER LN PORT LUDLOW WA 98365-9554 49 SUBDIVISION: PORT LUDLOW NO. 4 Block: Lot: PARCEL NUMBER: 990500049 Section: 8 Township: 28N Range: 01 E CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTPI983O6 Expires 09/26/2006 OWNER, ALLEN A UYEDA PHONE: (360)437-7813 if different: SHANNON L UYEDA 60 WARBLER LN PORT LUDLOW WA 98365-9554 PROJECT DESCRIPTION: INSTALL A/G 120 GAL PROPANE TANK, GAS INSERT AND GAS PIPING THIS PERMIT IS VALID FOR ONE YEAR AND IS NOT RENEWABLE. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 07/29/2006. REQUIRED INSPECTIONS: Tank/Line/Appliance: /,tJfseia/2 PeoP/we L,&J f,(' 9/g/a' tix.dz ) o le Vi s/oso4/ FinalApproval: e, q//5/,s ` BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS. Office Hours 9:00 a.m. -4:30 p.m. HOT LINE AVAILABLE 24 HOURS A DAY I:\F_BLD_Permit_Propane.rpt 10/29/19� / L _____._ ____ • WARBLER LAME a0 p 4-1 i 1 CONCRETE DRtvEWAY pkn 22-4 t. .6 N 21 % N `S to' 4:-2' S-to IA 'v F1replae -vtt— — — — ri I ZD cpNov. -far k. . l ( ti vercal `u N I, L111E 4 to < t g I a-2 ` "^ 21'-9., t3'-10 to-` - ,Z„,„._ 2 1PY:LV fleck 2 1 8 .9 Ili i LA 1 LOT 49 s gbes415)" ______ EI.J._ -cv [7. [ ',:(1 E 7:-N 86 7 24 I. JUL 292005 'I 60 WARBLER LARE.I PORT LUDLOW,WA • • hin Wd -1EFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIQAN$T PORT TOWNS E 98368 PH: (3601 t INSTALLATION PERMIT APPLICATION ' WOODSTOVE / PROPANE TANK PELLET STOVE OTHER f ____ (34"-"rAll't rlif Is this appliance(htg stove, hot water tank,furnace, etc.)to be installed in a Manufactured/MobYEHome�o SITE ADDRESS(911 #I Road Name): ; F) v CL r b le-4/ La ( ( . .� Pv✓ '( L t.t el t.p„) W ZIP Q�y �r 9 DIGIT PARCEL ID NUMBER / 1_o-s-c2o O `*7 - Legal Description; Blo0k Lot(e) Subdivision Name — Township North, Range .-- - WM Section 33 1L- - - PHONEJ�U '-/ .2. 3 3 6 APPLICANT J. 0 Y1 U- A. `-%-. MAILING ADDRESS c 5 / / 7 ` 0 / �j�/ 1 �)1�T Pie S, WQ- ..,.r--,- ZIP _. e eo V p PHONE �� no / 3 �~ �a_ �,� PROPERTY OWNER 1_!.l_ <I t y e del -- MAILING ADDRESS U ✓ 12 G"wei -----2 4 3 Co 3 -<CY�D<.e�_. _ �J a____a____ C ZIP ,�- ----_____ �y / t 1 i I `�L°I MN, PHONE 340 U '5S .�2'3.3e> CONTRACTOR 9- MAILING ADDRESS 7! 7 '�y,�f ._ -T y- / 0 / f' � ✓�7 ' ��- ZIP �d �n ✓ g lrJ4. 0 /li E__ EXP.DATE g'_/J - d,5 �_ q STATE LICENSE# � - FEDERAL I.D.# / / r l6-[f d--7Q Ci cthe By signing the application form, the applicant/Owner attests that the information provided herein Is true and correct to the best 01 theirrknowledge. Av material falsehood or any omission of a material fact made by the atipliCant/owner with respect to this application packet;nay result in this permitbeing null and v;; further agree to save, indemnify and hold harmless Jefferson County against all liabilities,judgments, court Costs, reasonable attorney's fees m d e,,,.,• h eu which may fr,aanywway2cCrue oA51nst Jefferson County as a raaUlt of or in ccnSegcC•nC0 a'the grsrn na of ty ves or r e se of re0,,red later inspections.inspections. Accessand anndright of entry to right of entry to theferson applicant's nproperrtytor structture shalpbesl requested and agents hall occurlduP ngtregular businessfh hours. review and any DATE I_-...__l.. APPLICANT SIGNATURE - - - . FOR OFFICE USE ONLY • l / O J RECEIPT# BASE PEE _ _. CASH/CK# DATE .....1,.. ../,....-. - TOTAL - u-IUME',PLNCI,JMINFOBLDG\FORMSIINSTALL,DDC11105(0 ,,-i COG OJ di31' Z'9bt'ELEEISE: b0 :- l r'_,klki.,`'=11�,+'El1 Tl_, i�t �-i� ,cp. C06 JEFFERSON OJNTY • . r} DEPARTMENT OF COMMUNITY DEVELOPMENT al ., 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax p� www.co.jefferson.wa.us/commdevelopment .els, G� Master Permit Application MLA: Project Description(include separate sheets as necessary): 7fl 5 j-,r,/l_t- lzi<D,i9N r` 1,9 A.).�- 6'4S //V. ,e7- S cgs r' /- Al it Tax Parcel C� Property //�� Number: I _ ' ' 60 ._ t� , Size: 9 C/ (acres/square feet) Site Address and/or Directions to Property: 6 C Cv'7 L 2 i--- ,i?G,'r LaL9LoGt/ L)/ 'e.r/ Property Owner(s)of Record: /j L L.Z. i.: Y- s/lVN Al 0Ai (e' YL D,;7 Telephone;,-; C '7)— 7 '/ 3 Fax: email: Mailing Address: ' 7,j7 A-:- Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies) ..... - - I 1 Building ❑Variance(Minor, Major or nEbie Fopomkc Use) I1i ❑ Demolition Permit ❑ Conditional Use[C(a),C( o ❑ Single Family ❑ Discretionary"D"or Unna ed,Use Classification ❑ Garage Attached/Detached ❑ Special Use(Essential Public 1=acilities)** ❑ Manufactured Home 0 Boundary Line Adjustment J U L L y £'J05 /, 0 Modular ❑ Short Plat** ❑ Commercial* ❑ Binding Site Plan** I 0 Change of Use ❑ Long Plat** ❑Address I . Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** ➢_4,Propane El Plat Vacation/Alteration** ❑ Allowed"Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions*" ❑ Stormwater Management ❑ Shoreline Management Substantial Development** ❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Variance ❑Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* 0 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 any required later inspections.Access and,right of entry to this property shall be requested and shall occur only during regular business hours. f / Signature: ( �� P1U Date: 7/2 / 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-tr s ra responsibility for adhe' /to ah/complying with the ESA. The Applicant has read this disclaim r and signs and dates it below. Signature: (-1l j/G f�(E\ Date: %-/O S G:\PermitCcnter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc ill OWNER BUILDER STATEMENT • The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that re rot licensed -}rac U ers d 11 they will be assuming the responsibility of the General Contractor for the proposed project. ! _� • L .' Signature: Date: 4, I JUL 2 9 2005 . GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: I I FAX: • 1170C/i� /tiJ /A), -- /5",.) ( ) ( - --) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: t VE,7�4,ep /V,5 4/9 77./x#.6. , NUMBER 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: f 1 Private well i I Two Party Type of Heat: Proposed: � Total: I_l Public 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: I 1 Underground Tank t Above ground Tank Size of Propane Tank: ;7 y L l J Heat Stove 11 Cook Stove 1 1 Woodstove 1•5 Fireplace Insert i i Hot Water Tank ❑ 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: 2NU Floor Base fee: Plas?A h-tom 9. OD 3fd 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: $ 5-35 - Decks Receipt Number: -7/ ?,/_-t j '7/ 8 t Other Cash/Check Number: a 7�5 � % qb ESTIMATED COST(REQUIRED) Date: C O� •Fair market value of all labor and materials foundation to finish V/6-5 Initials: a G:\Perm \itCenterFORMS\DRD FORMS\Master Permit Application 7-8-04.doc ——