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Home My WebLink AboutBLD2005-00712 UILDING PERMIT APPLICA ION BL Revviewiew T Tyy712 pe: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD05-00712 Received Date: 11/16/2005 SITE ADDRESS: 162 N ANDREW AVE PORT TOWNSEND, 98368 OWNER: MICHAEL J SWEENEY PHONE: LESLIE J SWEENEY 13725 174TH AVE NE REDMOND WA 98052 IRONDALE SUBDIVISION: Block: 142 Lot: 29-33 PARCEL NUMBER: 962114208 Section: 35 Township: 30 N Range: 01 W 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 DESCRIPTION INSTALLL 120 GAL A/G PROPANE TANK AND COOK STOVE TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2003 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: # OF STORIES: OCCUPANCY: 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: P FIWZNEPropane Tanks/Stoves $49.00 PRB 11/16/05 77419 Total: $49.00 NOV 1 u 2005 Jefferson County Planning Buildin Department 0 0 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 #: BLD05-00712 Received Date 11/16/2005 SITE ADDRESS: 162 N ANDREW AVE Issue Date 11/16/2005 PORT TOWNSEND, 98368 APPLICANT: MICHAEL J SWEENEY PHONE: LESLIE J SWEENEY 13725 174TH AVE NE REDMOND WA 98052 29-33 SUBDIVISION: IRONDALE Block: 142 Lot: PARCEL NUMBER: 962114208 Section: 35 Township: 30N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2006 OWNER, MICHAEL J SWEENEY PHONE: if different: LESLIE J SWEENEY 13725 174TH AVE NE REDMOND WA 98052 PROJECT DESCRIPTION: INSTALLL 120 GAL A/G PROPANE TANK AND COOK STOVE 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 11/16/2006. REQUIRED INSPECTIONS: Tank/Line/Appliance:"/K I /N%L--/,id ciCA, //vt9-�.5-- FinalApproval: ?‹.-12-4'151 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 -� • • SITE VISIT REPORT NOV i 5 1U05 (PLOT PLAN) JOB !')1�'�, ,�t ��__».t DATE : I I j of CONTACT: ADDRESS PHONE #: DIRECTIONS FAX #: Email PLANNER: • Ic i - I oii 0 • L I rir /r� Vec JEFFERSONOUNTY • / DEPARTMENT OF COMMUNITY DEVELOPMENT ` 621 Sheridan an Street • Port Townsend •Washington 98368 QV 15 Lwt� 450 • 360/379-4451 Fax K........ SN��S N p� www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: Project Description(include separate sheets as necessary): 11-0 p - Tax Parcel ( ^ Property �/ f Number: ` d� I( 't g-ip y Size: (acres/square feet) Site Address and/or Directions to Property: Property Owners)of Record: rn 1 K L S W ej Telephone: ifac - 'it 5 D4 5 7 Fax: v email: Mailing Address: 1 O 694- 3 SS f P i, {44-0 roc, /7_ 6( (1733 S Applicant/Agent(if different from owner): SLc h S Hirt P trap � / Telephone: 38S S7/" 7 Fax: email: n , Mailing Address: it)$S,3 , pr. P (. What kind of Permit?(Check each box that applies) Building ❑Variance(Minor,Major or Reasonable Economic Use) ❑ Demolition Permit ❑ Conditional Use[C(a),C(d),or C]** ❑ Single Family Li Discretionary"D"or Unnamed Use Classification ❑Garage Attached/Detached ❑ Special Use(Essential Public Facilities)** ❑ Manufactured Home 0 Boundary Line Adjustment 0 Modular ❑ Short Plat** ❑ Commercial* ❑ Binding Site Plan** ❑ Change of Use ❑ Long Plat*" ❑Address Li Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** ropane 0 Plat Vacation/Alteration** L i Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions** LI Stormwater Management 0 Shoreline Management Substantial Development** 0 Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline anagement Variance ❑Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment 0 Forest Practices Ad/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 besi ct as m n matt rs relatin ytd licatio r ermit(s). z. \TURF 8. 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 provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any r uired I ter inspections.A ss and right of entry to this property shall be r quested and shall occur only during regular business hours. Signature: /7 ///Q S Date: / 4 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-trans le responsibi'y for dher' g to and complying with the ESA. The Applicant has read this disclaim r and s' ns and it below. Signature: �+' N Date: , // 0 G:\PemtitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc • 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 they will be assuming the responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: • ,i n,�-,o ( 'k )3Es 75 7 ( ) MAILING DRESS: /Q 8,S 3 e�Q ` 0 ( EMAIL: CONTRACTOR'S LICENSE �"`�(�tyl T WAINS NUMBER: SL S( 27 O-7 7 Q e NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: O New ❑ Wood Existing: ❑ Sewer O Addition 0 Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System O Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: ❑ 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 anal i_! Underground Tank 'Above ground Tank Size of Propane Tank: /3 Q U Heat Stove Cook Stove [i Woodstove 0 Fireplace Insert 0 Hot Water Tank 0 Pellet Stov U 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: '- ;,,,,t •';" gnu Floor ` Base fee: ,, f, 1 3fa FIoc, Addiuunai 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: $ ; Decks Receipt Number: . 7 t-4( 1 Other Cash/Check Number: ESTIMATED COST(REQUIRED) Date: rc.,f •Fair market value of all labor and materials foundation to finish (A O�,— ' Initials: \1'cmntCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc e