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Home My WebLink AboutBLD2005-00552 • . 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 #: BLD05-00552 SITE ADDRESS: 44 SWANSON AVE Received Date 8/25/2005 PORT TOWNSEND, 98368 Issue Date 8/25/2005 APPLICANT: A TUCKER ALLEN DEBBY W ALLEN PHONE: 5704 WISTERWOOD WAY VOS1NO SUBDIVISION: OCEAN GROVE ESTATES#2 3 4 Block: 8 Lot: PARCEL NUMBER: 977100803 CONTRACTOR: Section: 24 Township: 30N Range: 02W SUNSHINE PROPANE 10853 RHODY DR PHONE: 385-5797 PORT HADLOCK WA 98339 Contractor's License SUNSHP"0 77QP Expires 11/17/2006 OWNER, A TUCKER ALLEN if different: DEBBY W ALLEN PHONE: 5704 WISTERWOOD WAY VOS1N0 PROJECT DESCRIPTION: INSTALL ZERO CLEARANCE PROPANE FIREPLACE 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 8/25/2006. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval; 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:1F_BLD_Permit_Propane.rpt 10/29/19 IUILDING PERMIT AP BLD05-0 PLICA�N 0552 Jefferson County Department of Community Development Review Type: 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD05-00552 SITE ADDRESS: 44 SWANSON AVE Received Date: 8/25/2005 PORT TOWNSEND, 98368 OWNER: A TUCKER ALLEN DEBBY W ALLEN PHONE: 5704 WISTERWOOD WAY VOS1N0 SUBDIVISION: OCEAN GROVE ESTATES#2 Block: 8 Lot: 3-4 PARCEL NUMBER: 977100803 Section: 24 Township: 30 N Range: 02 W CONTRACTOR: SUNSHINE PROPANE 10853 RHODY DR PHONE: 385-5797 PORT HADLOCK WA 98339 Contractor's License SUNSHP"077QP Expires 11/17/2006 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP INSTALL ZERO CLEARANCE PROPANE FIREPLACE 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: Propane Tanks/Stoves $49.00 PRB 08/25/05 76449 Approved/Date Total: $49.00 4 PP : n 1/ IOkHLtF:ipi AUG 2 5 2005 �ffersjr� ' °i ir, tY Pfamiinr; epartmen f �2 ifl ..¢SON co& JEFFERSONOUNTY • ' IA j DEPARTMENT OF COMMUNITY DEVELOPMENT ` `4:1 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax �p� www.co.jefferson.wa.us/commdevelopment �`�$INrs'S Master Permit Application MLA: Project Description(include separate sheets as necessary): l Nise— Z C OW t✓ . IC/ a 4 Ct_ ( 6-9s J Tax Parcel 9 O Q Property Number: 7 7 / 8 03 Size: (acres/square feet) Site Address and/or Directions to Property: r Sad 4414 471. f c.e , /6°i. To •-S[ Property Owner(s)of Record: / uCkee{, r // Telephone: 3(F - OVai Fax: email: Mailing Address: . 7o V ) 5 L. /J7at-cJ o aS /.LAti , So o f e C V 9 S I co Applicant/Agent(if different from owner): c I h Jh,�c� fz 75'. � Telephone: 3o J - 3 7 g 7 Fax: email: Mailing Address: /O 8�3 kL,0,17 6 r. P 7 . 2Vad(., a. 4)e ?P231 What kind of Permit?(Check each box that applies) i I 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 i i Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** Propane ❑ Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis Cl Shoreline Master Program Exemption/Permit Revisions** ❑ Stormwater Management El Shoreline Management Substantial Development** ❑ Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Variance ❑Temporary Use Cl 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 here designat ct as rn in matter citing to this ap I'cation ermit(s). OW GNATUR D 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 attomey'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 pro ' access and right of a try to Jefferson County and its employees,representatives or agents for the sole purpose of application review and an quired I ter' spection ccess and right of entry to this property shall be requested and shall r only during regular business hours. / Signature: _ Date: ,;7,3//:, 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 t he, a or it holds individual and non-tran Ife ble r ppnsibilit for adh n to and complying with the ESA. The Applicant has read this di era signs and dates it below. Signature: �f tL Date: d L 3/ S G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc • -,.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 CONTRACTOR OR MANUFA TURED HOME INSTALLER: PHONE: FAX: (r-43-7, _ (/60) 3 g)— 5 7i 7 ( ) MAILING ADDRESS: jJ � CP,S•3 Li ad� )T. EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: `ritn.r/P4e0 77 Ck_3 NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: 0 New 0 Wood Existing: ❑ Sewer ❑ Addition 0 Steel Proposed: Bank Li Community System ❑ Alteration/Remodel 0 Concrete Total: Height: Li !ndividual System 0 Repair 0 Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: 0 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: i, Underground Tank t i Above ground Tank Size of Propane Tank: z C g sy l7 Heat Stove LI Cook Stove t_] Woodstove ❑ Fireplace Insert Li Hot Water Tank ❑ Pellet Stove X Other F i fcP 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 I Amount Main Floor Consistency Review: 2Nu Floor Base fee: 4q •00 3 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: $ 44.On Decks Receipt Number: /6+4-6( Other Cash/Check Number: " 309 ESTIMATED COST(REQUIRED) Date: rG . •Fair market value of all labor and materials foundation to finish l ✓ - Initials: ?0 • G:\PemutCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc