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Home My WebLink AboutBLD2005-00621 ItUILDING PERMIT APPLICAIN BLD05-00621 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD05-00621 Received Date: 9/26/2005 SITE ADDRESS: 393 EAGLE RIDGE RD PORT HADLOCK, 98339 OWNER: JAMES RICH SMITH PHONE: CHERYL SMITH PO BOX 1488 PORT HADLOCK WA 983391488 EAGLE RIDGE LARGE LOT SUB SUBDIVISION: Block: Lot: 7+ PARCEL NUMBER: 921185007 Section: 18 Township: 29 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: 9"1,11004•440 PROJECT DESCRIPTIOt NO MLA REQ'D - ABOVE—GROUND 500 GALLON PR OPANE ROPANE TANK & 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: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: 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 CJZ 09/26/05 77009 Total: $49.00 • 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 #: BLD05-00621 Received Date 9/26/2005 SITE ADDRESS: 393 EAGLE RIDGE RD Issue Date 9/26/2005 PORT HADLOCK, 98339 APPLICANT: JAMES RICH SMITH PHONE: CHERYL SMITH PO BOX 1488 PORT HADLOCK WA 983391488 7+ SUBDIVISION: EAGLE RIDGE LARGE LOT SUB Block: Lot: PARCEL NUMBER: 921185007 Section: 18 Township: 29N 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, JAMES RICH SMITH PHONE: if different: CHERYL SMITH PO BOX 1488 PORT HADLOCK WA 983391488 GfitlLA,e6ROa,0 PROJECT DESCRIPTION: NO MLA REQ'D -ABOVE GROUND 500 GALLON PROPANE TANK & 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 9/26/2006. REQUIRED INSPECTIONS: Tank/Line/Appliance: 1/A1DEC6,e_0rtivD '/;gtJX LTX-(Er/oe Z),< /1d/05, FinalApproval: QK -off t r rt o_l (o//i/o 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 �-� 26 05 11 : 39a Levi 1 -360-385-5875 p. 2 SITE VISIT REPORT (PLOT PLAN) JOB N Iv R. Sm i DATE : CONTACT: ADDRESS PHONE #: • DIRECTIONS FAX #: Email PLANNER: ? Joy emu. J ♦p Gf4p,, s o rP2a 500Z 9 Z d3S 0 OWNER BUILDER STATEMENT IIIThe 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: I GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: f12-f P ( ) .2 CFS s.797 ( ) MAILING ADDRESS: /l062s'j 2 d, _ 8 r Pict. t[(. EMAIL: CONTRACTOR'S LICENSE `/I WAINS NUMBER: ,St t n J fr/PX O77 Q e NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: El New ❑ Wood Existing: Li Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# [1 Demolition 0 Other: ` Bedrvams. Water Supply: Existing: Setback: ❑ Private well I 1 Two Party Type of Heat: Proposed: ❑ Public Total: Name of System: 1 If this is a Commercial Project you must answer the following: I 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: Soo _ 4Y f. Heat Stove I Cook Stove I. Woodstove I i Fireplace Insect i i Hot Water Tank ❑ Pellet Stove V Other Gf!S PfP:- this appliance being installed in a Manufactured/Mobile Home? Yes / No rVhen 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: a l r 2""Floor — Base fee: 3f°Floor i----.__-_-_ -_ Additional Section: 1 Mezzanine: Plan Check fee: Heated Basement State Surcharge fee: Unheated Basement Pot Water Review fee: Other Unheated 911/Rd Approach fee: Garage/Carport TOTAL: $ P . •S 0 Decks At. -- Receipt Number: -11 Q°C-1 Other — Cash/Check Number: 3 3 - o ESTIMATED COST(REQUIRED) Date: W. (OS .Fair market value of all labor and materials foundation to finish Initials: ,.. \PemtitCenter\FORMS DRD FORMS M _\ \ later Permit AppLca[iun 7 8 U4.dur *TiiirSk`l d JEFFERSON•LINTYI� DEPARTMENT OF COMMUNITY DEVELOPMENT •1 k)r '•' 6.2005 621 Sheridan Street • Port Townsend •Washington 98368 • �w 360/379-4450 • 360/379-4451 Fax p� www.co.jefferson.wa.us/commdevelopment Isztrs Master Permit Application MLA: Project Description(include separate sheets as necessary): boo c & . tik,st --c�ract n( Pro,'& J k e ' a-S t7"110 Tax Parcel a p r/ Property Number: l( I - I p S- 0 0 t Size: (acres/square feet) Site Address and/or Directions to Property: 36/3 2?C L& R. e- O2• Po tici--t_c c.Qc Property Owner(s)of Record: R- -S vvi I Tt t Telephone: 31 1355 Fax: email: Mailing Address: P D P3 ox I't os - ( -r H 6.-a Lo ck >nl a q 83 31 Applicant/Agent(if different from owner): 5(44,4 ti-t h,e i°(L pTelephone: E 5 -5 711 n Fax: email: Mailing Address: I D$5 3 K In o Q r PT 1 f 1l ti)c I What kind of Permit?(Check each box that applies) ❑ Building 0 Variance(Minor, Major or Reasonable Economic Use) ❑ 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)** ❑Manufactured Home ❑ Boundary Line Adjustment ❑Modular Cl Short Plat** ❑Commercial* ❑ Binding Site Plan** D Change of Use ❑ Long Plat** ❑Address ❑ Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** >ropane 0 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: DESIGN ION OF AGENT • I he)bar-desi act as m n matt rs relatin licatio ermit(s). TURF e: 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 attorneys 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. and right of-entry to this property shall be r quested and shall occur only during regular business hours. / c� Signature: - Date: 9-0 2- `vim 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 • the J on County development code.The Applicant acknowledges that he,she or it holds individual and non-transferable responsibility f dheri and g with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: /l � NA Date: �' .`s- G:\PemutCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc