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Home My WebLink AboutBLD2005-00788 S ILDING PERMIT APPLICATI B RDOe 00788 Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD05-00788 Received Date: 12/28/2005 SITE ADDRESS: 880 DUCKABUSH RD BRINNON, 98320 OWNER: MICHAEL EASTMAN PHONE: 360-796-0039 GLORIA EASTMAN 880 DUCKABASH RIVER RD BRINNON WA 98320 SUBDIVISION: Block: Lot: T 33 PARCEL NUMBER: 502162003 Section: 16 Township: 25 N Range: 02 W CONTRACTOR: HOME GAS LLC PHONE: 360-898-9300 170 E 3RD ST UNION WA 98592 Contractor's License HOMEGGL9500W Expires 9/16/2007 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION PROP TANK ONLY TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC VALUATION MAIN: CODE EDITION: 2003 ADD'L: HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: # OF STORIES: 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 Bv: Date: Receipt: Approved/Date Propane Tanks/Stoves $49.00 LYK 12/28/05 78826 Total: $49.00 S 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 #: BLD05-00788 Received Date 12/28/2005 SITE ADDRESS: 880 DUCKABUSH RD Issue Date 12/28/2005 BRINNON, 98320 APPLICANT: MICHAEL EASTMAN PHONE: 360-796-0039 GLORIA EASTMAN 880 DUCKABASH RIVER RD BRINNON WA 98320 T 33 SUBDIVISION: Block: Lot: PARCEL NUMBER: 502162003 Section: 16 Township: 25N Range: 02W CONTRACTOR: HOME GAS LLC PHONE: 360-898-9300 170 E 3RD ST UNION WA 98592 Contractor's License HOMEGGL9500W Expires 9/16/2007 OWNER, BERNICE BE THOMPSON PHONE: if different: 27015 47TH AVE S APT 109 KENT WA 980327189 PROJECT DESCRIPTION: PROP TANK ONLY 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 12/28/2006. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval VJA> .. / �-b 6 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 goN coGigitk JEFFERS;OUNTY • DEPARTMENT OF COMMUNITY DEVELOPMENT $3 ` `.4 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax p$ www.co.jefferson.wa.us/commdeveloprnent Master Permit Application MLA: Project Description(include separate sheets as necessary): Pr i,,,,,e S7e y e Tax Parcel Property Number: SO 2 /C 2 D 0 3 Size: / 3 , n s 7 accrs_s (acres/square feet) Site Address and/or Directions to Property: ego Oa..c./c a,L.s Z R T ve r AZ,„,.X 13/r%•v.vrs,+.i 4. ' - - 11 Property Owner(s)of Record: FYI i aLe i t G/s Ni... f1:.....sr.-.ten, Telephone: 3 6 0 796 19039 Ear- S3 6 9 *9/1 email:ni7kt.nccim..v494).*".1n;ea Mailing Address: P,D. /3oar $'"96 Qi'%NN,,,, L✓/ 9a320 Applicant/Agent(if different from owner): Telephone: 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 ❑ Discretionary"D"or Unnamed Use Classification ❑ Garage Attached/Detached ❑ Special Use(Essential Public Facilities)** ❑ Manufactured Home ❑ Boundary Line Adjustment ❑ Modular ❑ Short Plat'"' ❑ Commercial* ❑ Binding Site Plan** ❑ Change of Use ❑ Long Plat** ❑Address [i Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** X Propane ❑ 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: 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 access and right of entry to Jeff son County and its employees,representatives or agents for the sole purpose of application review and any required later inspections. cess a ht of entry to this property shall be requested and shall occur only during regular business hours. Signature �� _ Date: /Z/, /�.f— 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 complian with th erson development code.The Applicant acknowledges that he,she or it holds individual and non-tra r nsi '' or ng to plying with the ESA. The Applicant has read this disclaimer a d signs nd dates it below. Signs Date: /2 .285 G:\PernutCenter\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: 1 Al t),-i.e (rams .4.te e. (360) 0 F e7,3 oo ( ) j MAILING ADDRESS: / 7 r0 £' " ( /i _ _s,� �� EMAIL: CONTRACTOR'S LICENSE �/ wV WAINS NUMBER: o It (.-4- � 1 v‘F 1 / !B 73 i `?5—pi,G✓ NUMBER ARCHITEe kf dCER' // PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel 0 Concrete Total: Height: 0 Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well I 1 Two Party Type of Heat: Proposed: 0 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 apply: I I Underground Tank )(Above ground Tank Size of Propane Tank: /20 ,1/. i 1 Heat Stove I l Cook Stove I i Woodstove I 1 Fireplace Insert 11 Hot Water Tank I 1 Pellet fove i 1 Other Is this appliance being installed in a Manufactured/Mobile Home? ne / 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 systemcomponentpr, including the reserve area. Cr} , C ;A 1ti,' Square Footage For Office Use Only Current Proposed • ount Main Floor Consistency Review „_=ok J a re (l 2"u Floor Base fee: sw l 00 3`d Floor Additional Section: Mezzanine: Plan Check fee: Heated Basement State Surcharge fee: Unheated Basement Pot Water Review fee: Other Unheated 911/Rd Approach fee: ---7 `� Garage/Carport l ` S TOTAL: $ Decks n S� Receipt Number: I Other Cash/Check Number: A ESTIMATED COST(REQUIRED) Date: •Fair market value of all labor and materials foundation to finish L Zr 1 Initials: 4 --4 .-- G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc TV N O c- m n '''''..."-............,<.,„,,,,..„,,,,,.... -I D 3 m e-,L£,1 A 1d4v •LL I% Div .. 1 �e j. iNA 1 w k Jr811 ...a., -% , 9ti ahxaz aw.iN ( ,1 I 0w.ialsbr1 ss Y�,�V..e.,Ar1014/ W.A./alb 16 •001•wyes, 4011 : i :,- -,-,-/.(dy ..., Mrn 18"T� x Ot vy . •s1 c i tIM n 4.,j`j - 14 P.01---f e 4 ‘Iir.,,,aptiv.s. • \ t k ..... eiiv :A., rii P,If)..„ 0 r ` rn ` I I 1 1 -I 1 i r 1 I .4 rn 1 , 0 w A w H 1 \ \ i 1 ' I E. y ' \ \ io I N•'m \ 1� • NC" % •d`4. • i -Iiii. i oil ‘`ti- • ti. ; )t: A ` ' I Z 1 c I ^3 ' ` r c Om i on 4z i 1 I %° , N -Vviir n, biZ -tie` spa• , k. .t I • _ .,__ a •ob h 41 00 w 4 0