HomeMy WebLinkAboutBLD2006-00126 BLD06-00126
itJILDING PERMIT APPLICATIN Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD06-00126
Received Date: 3/20/2006
SITE ADDRESS: 2481 ANDERSON LAKE RD#610
CHIMACUM, 98325
OWNER:
EVERGREEN COHO ESCAP RETREAT PHONE: (360) 385-6538
2481 ANDERSON LAKE RD
CHIMACUM WA 98325-9795
EVERGREEN COHO ESCAPEE RESORT
SUBDIVISION: Block: Lot: 227
PARCEL NUMBER: 901101039 Section: 10 Township: 29 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 09/07/2006
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP INSTALL AIG 120 GAL PROPANE TANK AND GAS PIPING (YOUNG)
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: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
CONST TYPE: DECK: 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 03/20/06 80862
Total: $51.00
• •
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 #: BLD06-00126
SITE ADDRESS: 2481 ANDERSON LAKE RD#610 Received Date 3/20/2006
CHIMACUM, 98325 Issue Date 3/20/2006
APPLICANT: WILBUR L YOUNG
2481 ANDERSON LK RD#610 PHONE: (360) 385-2504
CHIMACUM WA 98325
SUBDIVISION: EVERGREEN COHO ESCAPEE RE 227
PARCEL NUMBER: 901101039 Block: Lot:
CONTRACTOR: Section: 10 Township: 29N Range: 01W
CHSINC
PO BOX 518 PHONE: (360)732-4585
AUBURN WA 98071-0518
Contractor's License CHSIN**9790Z Expires 09/07/2006
OWNER, EVERGREEN COHO ESCAP RETREAT
if different: 2481 ANDERSON LAKE RD PHONE: (360) 385-6538
CHIMACUM WA 98325-9795
PROJECT DESCRIPTION: INSTALL A/G 120 GAL PROPANE TANK AND GAS PIPING
(YOUNG)
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 03/20/2007.
REQUIRED INSPECTIONS:
Tank/Line/Appliance:
FinalApproval:
BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HCURS IN ADVANCE TO SCHEDULE INSPECTIONS.
Office Hours 9:00 air. -4:30 p.m.
HOT LINE AVAILABLE 24 HOURS A DAY
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kilo�' DEPARTMENT OF COMMUNITY DEV P E�1
621 Sheridan Street • Port Townsend•Washington 98368
� y 360/379-4450 • 360/379-4451 Fax
.gs No,„ www.cojefferson.wa.us/commdevelopmemAR 2 0 2006
Master Permit Application JEffEDSO1i COUNTY DIf LA:
Project Description (include separate sheets as necessary)):`
PfL:>PANr= -T71tilg_ ?LACE_TMEAQ i Ont RV' c-oT-
Property
Tax Parcel Number: CI-0 1 0 ( CS 5j Size: (acres/square feet)
Site Address and/or Directions to Property: Z`f-e( 4N,7atspro Lk K12° to(0) C,� H
, Ac�df4i t-J4 ct o S 25
Property Owner(s)of Record: £vim/ z e.i r c uC; Sic P ra 2K
Telephone: (sbo) 3Ets,-(,53i( Fax: (3i c) 3 W- ..104,2 email: 2Ge'5kr e esCApRe-s.c6r4,1
Mailing Address: Z/- ( /1tiDc25o4. 1,/}t e R Cu iPRCur41 1-..1A qQ- 2S
Applicant/Agent(if different from owner): (4.C'1 ') Wr1-' -t' L.' Y�u,vc,
Telephone: (3(..4.2) 355- ZSU,-f Fax: email: w,iyowij 2 alypeK,
Mailing Address: 2'8t A-,voeQ. L/ PD w6,10 C,--f 0444c-ua-c WA q'32S
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 ❑ Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments**
) .Propane 0 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:
E IGNATION OF AGENT
I hereby designate /✓Ei 6 Z/ n1 O)Pt( .SIG % /;to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE -th, olC-'��9^^—� V/CLI t`vi it P .c)T— Date: 0-5/z.c1/G'‘c
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 required later inspections.Access and right of entry to this property shall be requested and shall occur only during regular business
hours. t
Signature: 'W ' Date: C 3/1 7 /olio
The action or actions Applican ill 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-
transferable responsibi"ty foradhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: ,W` Date: 6-3 i i7 O
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc
• 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 CQNTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
Le. e ( ) ( )
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 0 Wood Existing: 0 Sewer
❑ Addition 0 Steel Proposed: Bank Height: 0 Community System
❑ Alteration/Remodel 0 Concrete Total: ❑ Individual System
❑ Repair 0 Masonry SEP Permit#
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: 1 i Private well i i Two Party
Type of Heat: Proposed: I I 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 `tr Above ground Tank Size of Propane Tank: /! )
Heat Stove h% L Cook Stove I Woodstove ; Fireplace Insert ❑ Hot Water Tank ❑ Pellet Stove I4 Other FT, )A
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 Current Proposed For Office Use Only Amount Revision
Main Floor Heated EH Bld App Review:
2nd Floor Heated Consistency Review: .25
Other Heated Base fee:
pio(X lle 51 ' C)C-)
Mezzanine Additioonal Section:
Heated Basement Plan Check fee: RECEIATED
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Review fee: 1-^'� 2 0 2006
Garage/Carport SUBTOTAL � yy h'
Decks 911/Rd Approach fee: lfffERNI\ bo I T' R:cB
Other TOTAL: $ `7l0 • 9D
Receipt Number: %P)%t _ a
Cash/Check Number: Ua l l°1
ESTIMATED COST(REQUIRED) Date: \a016cio
.Fair market value of all labor and materials foundation to finish
Initials:
r\�
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc