HomeMy WebLinkAboutBLD2006-00077 tILDING PERMIT APPLICATIN BLD06-00077
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD06-00077 Received Date: 2/24/2006
SITE ADDRESS: 40 S LYTER AVE
PORT TOWNSEND, 98368
OWNER: JAMES H ELLIS PHONE: (360) 379-3925
JESSICA ELLIS
4968 MAGNOLIA ST
PORT TOWNSEND WA 98368 IRONDALE
SUBDIVISION: Block: 154 Lot: 31-35
PARCEL NUMBER: 962115409 Section: 35 Township: 30 N Range: 01 W
CONTRACTOR: NORTHWEST FIREPLACE & GAS SYSTE PHONE: (360)377-1457
1120 PEARL ST
BREMERTON WA 98310
Contractor's License NORTHFG044KG Expires 05/07/2006
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr INSTALL 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
Propane Tanks/Stoves $51.00 KAS 02/24/06 79125
Total: $51.00
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PROPANE/PELLET/WOOD STOVE & TANK INSTALLATION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD06-00077 Received Date 2/24/2006
SITE ADDRESS: 40 S LYTER AVE Issue Date 2/24/2006
PORT TOWNSEND, 98368
APPLICANT: JAMES H ELLIS PHONE: (360) 379-3925
JESSICA ELLIS
4968 MAGNOLIA ST
PORT TOWNSEND WA 98368 31-35
SUBDIVISION: IRONDALE Block: 154 Lot:
PARCEL NUMBER: 962115409 Section: 35 Township: 30N Ranqe: 01W
CONTRACTOR: NORTHWEST FIREPLACE & GAS SYSTEMS PHONE: (360)377-1457
1120 PEARL ST
BREMERTON WA 98310
Contractor's License NORTHFG044KG Expires 05/07/2006
OWNER, JAMES H ELLIS PHONE: (360) 379-3925
if different: JESSICA ELLIS
4968 MAGNOLIA ST
PORT TOWNSEND WA 98368
PROJECT DESCRIPTION: INSTALL PELLET STOVE
THIS PERMIT IS VALID FOR ONE YEAR AND IS NOT RENEWABLE.
THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR.
THE EXPIRATION DATE IS 02/24/2007.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: 2(--% 4,07
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FinalApproval 2.rcttt�0
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BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS.
Office Hours 9:00 a.m. -4:30 p.m.
HOT LINE AVAILABLE 24 HOURS A DAY
I:\F_BLD_Permit_Propane.rpt 10/29/19c
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JEFFERSOUNTY
,.. DEPARTMENT OF COMMUNITY DEVELOPMENT
''d 621 Sheridan Street • Port TowgaenIf1 • Wa$t}irlgtonj 3 )
4 ) 360/379-4450 • 360/379-4451 tar
qS,•trINGc3 www.co.jefferson.wa.us/commdevelopment
Master Permit Application EB 4 2006
Project Description (include separate sheets as necessary): a�r[ {I�I ('(III i}� I"t
i MLA:
ejk-A- S- R( [r F1 J1Y 1,UU t,L
Tax Parcel Number: Oki)..._ 1 t ,I w Property _ r j L
Size: 12 I 1 S�X.-1--1 (acres/square feet)
Site Address and/or Directions to Property: -P i L1 Ut�� 6' i J L Atr
Property Owner(s)of Record: J(A T\ c ` e ( , -\ " v7
Telephone: C "] " C c/15 Fax:
Mailing Address: �p /� //,, email:
Applicant/Agent(if different from wner):
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 1 Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments**
❑ 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
Please identify any other local, state or federal permits required for this proposal,,ift known:
ion erence
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 attorney'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 quired later inspections.Access and right of entry to this property shall be requested and shall occur only during regular business
hours.
Sign / titeSignature: �L' �„.
Date: i
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 call 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-
transferable resl5otisibility fo(c adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and.date§it below.
Signature: L/ . , Date: , 1
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G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc