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Home My WebLink AboutBLD2005-00653 • fri 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 #: BLD05-00653 Received Date 10/11/2005 SITE ADDRESS: 12 DRIFTWOOD CT Issue Date 10/11/2005 PORT LUDLOW, 98365 APPLICANT: HARLIN A CHEATWOOD TRSTE PHONE: ANDREA S CHEATWOOD TRSTEE PO BOX 1468 LA QUINTA CA 922471468 12 SUBDIVISION: LUDLOW POINT VILLAGE DIV 4 Block: Lot: PARCEL NUMBER: 969800012 Section: 17 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, HARLIN A CHEATWOOD TRSTE PHONE: if different: ANDREA S CHEATWOOD TRSTEE PO BOX 1468 LA QUINTA CA 922471468 PROJECT DESCRIPTION: NO MLA REQ'D - HEAT STOVE & 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 10/11/2006. REQUIRED INSPECTIONS: Tank/Line/Appliance: /1/,�1tJ /A r6R/Oe Liti,,•" �fl � '�E -i ,�Jj,�f�tl� �T4 ✓� /9 q W FinalApproval: —(6)r +3,-;41.1 k /f /)s e0 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£ BUILDING PERMIT APPLICAIN BLD05-00653 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD05-00653 Received Date: 10/11/2005 SITE ADDRESS: 12 DRIFTWOOD CT PORT LUDLOW, 98365 OWNER: HARLIN A CHEATWOOD TRSTE PHONE: ANDREA S CHEATWOOD TRSTEE PO BOX 1468 LA QUINTA CA 922471468 LUDLOW POINT VILLAGE DIV 4 SUBDIVISION: Block: Lot: 12 PARCEL NUMBER: 969800012 Section: 17 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 DESCRIPTIOl NO MLA REQ'D - HEAT STOVE & 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: CONST TYPE: OTHER: GARAGE: SHORELINE: CONST TYPE: 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 10/11/05 77033 Total: $49.00 SITE VISIT REPORT (PLOT PLAN) JOB CA1tA oc,c DATE : 61/zcii° . CONTACT: ADDRESS PHONE #: DIRECTIONS FAX #: Email PLANNER: n..� /\ L I:? IYzcssr 4i 0 1 15 • ; 4., Lis; fro 1„. • i 1 v/ i ll NEE0 a- ex s(C),-) L$100E 2S t/3 c► lt•Dl s�rac u SE 4` A-s4 (.0 K IT PVT va P 146DUC 2—/fr U.� C o6 JEFFERSON fai UNTY • �' DEPARTMENT GIWOMMUNITY DEVELOPMENT 4i14.4 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax 4Isztiv , GtO� www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: Project Description(include separate sheets as necessary): t ,-,--)40 F P Pam.. Tax Parcel G� Property Number: / O 60 G Z Size: (acres/square feet) Site Address and/or Directions to Property: /')- 2' 4 o 0( j • Property Owner(s)of Record: Telephone: 4 - cv,.0 Z3 Fax: email: Mailing Address: F &,s> //f 1 r?' Lam, q/ 7.'2 74 .-i < V 7 Applicant/Agent(if different from owner): 6r-r-n S l h L PRror4-r7 i` Telephone: 342 O 3 8.S -57 S 7 Fax: 3 8 5 58 75 email: Mailing Address: /0 P 3 //h a d ty dr. pi . 1-I ftO LO((C, Lk)F) 5 83 3 7 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)** 0 Single Family ❑ Discretionary"D"or Unnamed Use Classification 0 Garage Attached/Detached 0 Special Use(Essential Public Facilities)** 0 Manufactured Home 0 Boundary Line Adjustment ❑ Modular 0 Short Plat** 0 Commercial* 0 Binding Site Plan** ❑ Change of Use 0 Long Plat** 0 Address 0 Road Approach 0 Planned Rural Residential Development(PRRD)/Amendments** ropane 0 Plat Vacation/Alteration** Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions** 0 Stormwater Management ❑ Shoreline Management Substantial Development*' ❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Variance 0 Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment 0 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 here. de 'gnat �/411111- _,' i.s"'-� y age ;..slating to j -iiii .tion for permit(s). OWN IGNATUREts._ _./ 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 f provi e access nd right of entry to Jefferson Countyand its employees,re representatives or agents for the sole u review a , requir later' ctions.A P purpose of application d�igl3t of en this property shall be requested and shall occur only during regular b ' hours. / tgna re• Date: /b / O' i r I TThe 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." efferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has bee i` ued will not Iola • the ESA. An i. d' idual,grou r agency can file a lawsuit on behalf of an endangered species regarding your ‘Ikijo action . e 1 you arf in . is - with •- iir on County de a pment code.The Applicant acknowledges that he,she or it hol rvtdual a•• non-trab erable -.pc,s' it * -dhering t . t; pl ing wi the ESA. The Applicant has read this ' imer/'nd.si nd 3"d datesbelow. •� • Date: G:\I'ctnutCetucr\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc OWNER BUILDER STATEMEi4, lir The signer of this statement does hereby certify th y are troa Owners of the parcel referenced herein,thatare not licensed they will be assuming the responsibility of the General Contractor for the proposed project. they contractors and that Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: ra ) ass 7 G 7 ( )MAILING ADDRESS: /0S537?1?a 10C E :CONTRACTORS LICENSE WAINSNumBER. Sz'hsHin d! 7VP NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAx ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: ❑ Type of Sewage Disposal: New 0 Wood Existing: 0 Sewer ❑ Addition 0 Steel Proposed: Bank 0 Community System ❑ Alteration/Remodel 0 Concrete Total: Height: ❑ Individual System ❑ Repair 0 Masonry SEP Permit# 0 Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: Type of Heat: Proposed: D Private well ❑ Two Party Total: 0 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: ❑ Underground Tank ❑ Above ground Tank Size of Propane Tank: t�i—u uri-- X Heat Stove ❑ Cook Stove ❑ Woodstove 0 Fireplace Insert ❑ Hot Water Tank 0 Pellet Stove X Other `ice 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 ?-12a . ,& Current Proposed ,pp,�"�� 1+ ^.K " Main Floor #110..p 'Consistency:Reviow: ', li, 'In:-, , 2""Floor (fin, FN 3$i Base fee: .4 .. oe 1 �3"a-Fbor .� � �Z ��,�� 1 sty ,o->�t Additional Section: • , x` Mezzanine: Plan Check fee: y z ;, gi, fi; z tyy ells;f 7.!4i, , g ,^ if Heated Basement State Surcharge fee; r sy Unheated Basement �t ,.4. '�', st Pot Water.Review fpps� ,` ��` �� Other Unheated -- . '...:':''Inv, vt4 , : 911/Rd Approach fee: F`,+�t.�x, 1 Garage/Carport t) { V011/K � „h , ITOTAL: $ �+ Y 1, Decks r Receipt Number: ''' `i Other Cash/Check Number r r t 1y t`�-; ESTIMATED COST(REQUIRED) v� 3 le Date: '=alb II v6.. - „ (. .Fair market value of all labor and materials foundation to finish <� �" Initials: r• t: r .n . +): } i;:\1'rmnitCcnter\FORMS\DRD FORMS\Master i'ennit Applicauuiji-o-u4.doc