HomeMy WebLinkAboutBLD2005-00749 1VINEW
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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 #: BLD05-00749 Received Date 12/2/2005
SITE ADDRESS: 21 AZALEA AVE Issue Date 12/2/2005
BRINNON, 98320
APPLICANT: BERNARD DELETTREZ PHONE: 360-297-5343
GHISLAINE DELETTREZ
30174 PARCELLS RD NE
KINGSTON WA 983468611 10
SUBDIVISION: PLEASANT TIDES DIV 2 Block: Lot:
PARCEL NUMBER: 988600010 Section: 15 Township: 25N Range: 02W
CONTRACTOR: ADVANCED INSTALLATION INC PHONE: 425-745-5977
16504 HWY 104 STE 101
LYNNWOOD WA 98037
Contractor's License ADVANII033DU Expires 3/13/2006
OWNER, BERNARD DELETTREZ PHONE: 360-297-5343
if different: GHISLAINE DELETTREZ
30174 PARCELLS RD NE
KINGSTON WA 983468611
PROJECT DESCRIPTION: NEW PELLET 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 12/2/2006.
REQUIRED INSPECTIONS:
Tank/Line/Appliance:
Fin al Approval:: r C_Dv
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
ILDING PERMIT APPLICAN B RD05-00749
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Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD05-00749 Received Date: 12/2/2005
SITE ADDRESS: 21 AZALEA AVE
BRINNON, 98320
OWNER: BERNARD DELETTREZ PHONE: 360-297-5343
GHISLAINE DELETTREZ
30174 PARCELLS RD NE
KINGSTON WA 983468611 PLEASANT TIDES DIV 2
SUBDIVISION: Block: Lot: 10
PARCEL NUMBER: 988600010 Section: 15 Township: 25 N Range: 02 W
CONTRACTOR: ADVANCED INSTALLATION INC PHONE: 425-745-5977
16504 HWY 104 STE 101
LYNNWOOD WA 98037
Contractor's License ADVANII033DU Expires 3/13/2006 1
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION NEW PELLET 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: Approved/Date
Permit $49.00 SLE 12/02/05 77448
Total: $49.00
4"-- yON �, •
OG JEFFERSO OUNTY
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,� DEPARTMENT OF COMMUNITY DEVELOPMENT
`' •4 F 621 Sheridan Street• Port Townsend • Washington 98368 -2 2005
360/379-4450• 360/379-4451 Fax
�ykjNG�p� www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA:
Project Description(include separate sheets as necessary):
:1- tJ S-4 cL i A n
iC, 4 lL-C l Si V I) 6-
Tax Parcel q Property
Number: 1 ej Pj C,an0 $/(6 Size: 1011 (;)j 5_, p (asFes/square feet)
Site Address and/or Directions to Property: .2( AZ e 1e4 L,rkrre P21 Nfro&J L/i4
Property Owner(s)of Record: B i12.iJ AQ.& t 6 i-t i S L A-i U G b t= L l' 1 I e t=2-
Telephone: 36 O - .' 7 • 5 3 y 3 Fax: 3 4-0 --A y 7-53y3 email: bj (�(j'6-1;�lSN .C'DM .
Mailing Address: 3'( 7c( Q/},2cs e 1t 2 k iJL k/Sul s A..) W i q �(-iy6
Applicant/Agent(if different from owner): N/A
Telephone: -i^ Fax: , — email: . -
Mailing Address:
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 i Discretionary"D"or Unnamed Use Classification
Garage Attached/Detached , Special Use(Essential Public Facilities)**
Manufactured Home J Boundary Line Adjustment
Modular 1 Short Plat**
i Commercial* i Binding Site Plan**
; Change of Use 1 Long Plat**
I Address i Road Approach ;I Planned Rural Residential Development(PRRD)/Amendments**
greparae Cep\e-T- 9 iw e I Plat Vacation/Alteration**
Allowed"Yes"Use Consistency Analysis _I Shoreline Master Program Exemption/Permit Revisions**
1_j Stormwater Management I I Shoreline Management Substantial Development*"
L_i Site Plan Approval Advance Determination(SPAAD)* i! Shoreline Management Variance
I Temporary Use H Comprehensive Plan/UDC/Land Use District Map Amendment
_I 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 hereby designate________, _____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 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 ess and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
review and any required er inspection ss and right of entry to this property shall be requested and shall occur only during regular business
hours. ,
Signature: Date: //3/2/d
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 age in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transferable'responsi ,lj fiir ad ring to and complying with the ESA. The Applicant has read this disclaimer end signs and dates it below.
Signature: - -t_.—L Date: -Sz VdS
C:\Docu nts and Settings\mochil\Desktop\Master Permit Application 7-8-04.doc
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OWNER BUILDER STATEMENT
The signer of this s nt does y certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that
they will be assumi a reespo ibili of >General Contractor for the proposed project.
Signature: i tea( ,�" Date: ,v,,/C',r
.
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
4({ V ct= -/--,t,s-in c_4 ?v,o ( '03") 7q - 64401/ ( )
MAILING ADDRESS: i 6 5dtI ( f 9� ci:i—e'/f L7�� /)=MAIL: Ai/
CONTRACTOR'S LICENSE t�J yW ggd,37 QWAINS
NUMBER: Al.i At t 1 ,,,( 3&D u NUMBER 6 di 7y7 O
ARCHITECT/ENGINEER: T t '�—'tU PHONE ( ) ----- FAX:( )
MAILING ADDRESS: EMAIL .------
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
New ( Wood Existing: i Sewer
1 Addition ri l Steel Proposed: Bank I_ Community System
n Alteration/Remodel r I Concrete Total: Height: r Individual System
[i Repair i l Masonry SEP Permit#
i Demolition rI Other: Bedrooms: Water Supply:
Existing: Setback: 1 I Private well 1 Two Party
Type of Heat: Proposed: Public
Total: Name of System:
If this is a Commercial Proiect 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 I Above ground Tank Size of Propane Tank:
i Heat Stove i Cook Stove i Woodstove i Fireplace Insert i Hot Water Tank ( Ilet Si-o-0 i 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:
2Nu Floor Base fee: 1Gj -
U v
3rd 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: $ UG •C)C)
Decks Receipt Number: 3� 1 TO ` `
Other Cash/Check Number: cAJi_f
ESTIMATED COST(REQUIRED) Date:
.Fair market value of all labor and materials foundation to finish 12/_"r/O
Initials: i l
C:\Documents and Settings\mochil\Desktop\Master Permit Application 7-8-04.doc v
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