HomeMy WebLinkAboutBLD2005-00741 0UILDING PERMIT APPLICAPON BL
Revviewiew T Ty741
ype:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD05-00741 Received Date: 11/29/2005
SITE ADDRESS: 85 MC MINN RD
PORT TOWNSEND, 98368
OWNER: LUISE MULLER PHONE:
85 MCMINN RD
PORT TOWNSEND WA 98368
SUBDIVISION: Block: Lot: T 46
PARCEL NUMBER: 001072020 Section: 7 Township: 30 N Range: 01 W
CONTRACTOR: C H S INC PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CHSIN**9790Z Expires 9/7/2006
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr INSTALL 250 A/G PROPANE TANK AND PIPING
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: API(` i i ti.i E D
Propane Tanks/Stoves $49.00 PRB 11/29/05 77544
Total: $49.00 NOV 6142005
Jefferson County Planning
4.A._
& Buil ' g Department
V �,
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 #: BLD05-00741 Received Date 11/29/2005
SITE ADDRESS: 85 MC MINN RD Issue Date 11/29/2005
PORT TOWNSEND, 98368
APPLICANT: LUISE MULLER PHONE:
85 MCMINN RD
PORT TOWNSEND WA 98368
T 46
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 001072020 Section: 7 Township: 30N Range: 01W
CONTRACTOR: C H S INC PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CHSIN**9790Z Expires 9/7/2006
OWNER, LUISE MULLER PHONE:
if different: 85 MCMINN RD
PORT TOWNSEND WA 98368
PROJECT DESCRIPTION: INSTALL 250 A/G PROPANE TANK AND 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 11/29/2006.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: �(— ---
FinalApproval: l b .( I.-p I
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
iics.
icy �� JEFFE N COUNTY
1W DEPARTMENT OF COMMUNITY DEVELOPMENT ro N`
' 621 Sheridan Street• Port Townsend • Washington 98368
,,f ' • 360/379-4450 • 360/379-4451 Fax
vYS, INC
www.co.jefferson.wa.us/commdevelopment
Master Permit Application
Proiect,Qescription(include seoaiate sheets,� as necessa MLA:
Tax Parcel
Number: G'1�1 / C}-'-2 v 7 /1 Property
Size: •
(acres/square feet)
Site Address and/or Directions to Pr perry: f �" `�
Property Owner(s)of Record: --1,
G` �"` � d` �� /,/ /
Telephone: / ' - '� 3 .
Fax: email: —
Mailing Address: Cc , t_}....
Applicant/Agent(if duff:rem from owner):Telephone: , �Q/ — � � --�Gu�
_ Fax: i • ,
Mailing Address: / " email:
3
What kind of Permit?(Check each box that applies)
0 Building
❑ Demolition Permit 0 Variance(Minor,Major or Reasonable Economic Use)
❑Single Family 0 Conditional Use[C(a),C(d),or C)**
0 Discretionary"D"or Unnamed Use Classification
❑Garage Attached/Detached
❑Manufactured Home 0 Special Use(Essential Public Facilities)**
0 Modular ❑ Boundary Line Adjustment
0 Commercial* ❑ Short Plat**
❑ Change of Use 0 Binding Site Plan**
0 Address0 Long Plat**
t 'Add ess— 0 Road Approach 0 Planned Rural Residential Development(PRRD)/Amendments**
o Allowed"Yes^Use Consistency Analysis 0 Plat VacatioNAlteration**
❑ Shoreline Master Program Exemption/Permit Revisions**
0 Stormwater Management
0 Site Plan 0 Shoreline Management Substantial Development**
Approval Advance Determination(SPAAD)*
0 Temporary Use ❑Shoreline Management Variance
0 Wireless Telecommunication* ElComprehensive PIaNUDC/Land Use District Map Amendment
0 Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment
*Ma -.uire a Pre—• ..ication Conference .*
Please identify any other local, state or federal permits required for th ssp proposal, if known:Conference
I hereby designate DESIGNATION OF AGENT
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 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 u
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. purpose of application
Signature:
Date: i i /
The action or actions Applicant will undertake as a result of the issuance of this
permit
may negatively impact upon
endangered species and could lead to a potential"take"of an endangered species as those terms are defined in one or more threatened or
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
action(s)even if you are in compliance with the Jefferson County development code.The
and non-transf able responsibilityg species regarding your
for adhering to and complyingwith the ESA. The Applicant acknowledges that he,she or it holds individual
Signature: Applicant has read this disclaimer and signs and dates it below.
Date: // — c_`�-
G\PermitCen ter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
6.
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
f c Date:
Contractor for the proposed project.
.7C t�..Z
Signature: ;��Liz-,e - -
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAx:
/v ( ) ( )
t-Al f
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAx:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New ❑ Wood Existing: 17 Sewer
❑ Addition 0 Steel Proposed: Bank ❑ Community System
❑ Alteration/Remodel 0 Concrete Total: Height: ❑ Individual System
❑ Repair ❑ Masonry SEP Permit#
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Party
Proposed: ❑ Public
Type of Heat: Total: Name of System:
If this is a Commercial Prolect 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 ap/llyr
❑ Underground Tank Above ground Tank Size of Propane Tank: :\S v
❑ Heat Stove X.Cook Stove 0 Woodstove ),Fireplace Insert ❑ Hot Water Tank ❑ Pellet Stove ' Other.4031(.1iE'L_
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. I
Amount
Square Footage For Office Use Only
Current Proposed
Main Floor Consistency Review:
—.
2Nu Floor Base fee: )
l r i. v(L a1t C
13f0 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: $ '"i JC',,
Decks Receipt Number: 1'7 S L4
Other _ — — Cash/Check Number: ;' 1 G
ESTIMATED COST(REQUIRED) Date: I Z ci
.Fair market value of all labor and materials foundation to finish l
Initials: P1P-
.____
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
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