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Home My WebLink AboutBLD2006-00169 BLD06-00169 .tILDING PERMIT APPLICATiN Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00169 Received Date: 4/10/2006 SITE ADDRESS: 536 OLYMPUS BLVD PORT LUDLOW, 98365 OWNER: JERRY L WETHERBEE PHONE: 360-437-1349 GLENDA R WETHERBEE 536 OLYMPUS BLVD PORT LUDLOW WA 983659434 OLYMPUS BEACH SUBDIVISION: Block: Lot: 17 PARCEL NUMBER: 978900012 Section: 4 Township: 28 N Range: 01 E CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2006 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION A/G 250 GAL PROP TANK -SWAP OUT TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW 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: 4 1 to(oco -_ Type Amount Paid By: Date: Receipt: Approved/Date Permit $51.00 LYK 04/10/06 8'009 Total: $51.00 • • 4 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 #: BLD06-00169 Received Date 4/10/2006 SITE ADDRESS: 536 OLYMPUS BLVD Issue Date 4/10/2006 PORT LUDLOW, 98365 APPLICANT: JERRY L WETHERBEE PHONE: 360-437-1349 GLENDA R WETHERBEE 536 OLYMPUS BLVD PORT LUDLOW WA 983659434 17 SUBDIVISION: OLYMPUS BEACH Block: Lot: PARCEL NUMBER: 978900012 Section: 4 Township: 28N Range: 01 E CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2006 OWNER, JERRY L WETHERBEE PHONE: 360-437-1349 if different: GLENDA R WETHERBEE 536 OLYMPUS BLVD PORT LUDLOW WA 983659434 PROJECT DESCRIPTION: A/G 250 GAL PROP TANK -SWAP OUT 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 4/10/2007. REQUIRED INSPECTIONS: Tank/Line/Appliance: � &� 3/5/07 FinalApproval: t2X i'oy NQ.,I 3/07 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 ..r,4 • • .. f. SITE VISIT REPORT (PLOT PLAN) it y -is- GL,E,(iM lit)E ThER,e ATE : 00,,S70 6 . CONTACT: 1RESS �3‘' OLYfl—? PLVi6, PHONE #: 4!3 ? -7?y 7 : :CTIONS f oX.T L ceSL,o c....., ,,.b+�-,.s sfh„ FAX #: Email . PLANNER: . W iti\IP 1 APR 10 2006 '. . !( , - . ' -. . , I t/1 Pp I4 ►vins � oom •, '�...01 C (4.441-A/ . I \ 0 _ Io' ! an k 6 cwa--p- ou i i Sa►ne_._ s/ Z.t. I , am,Qit- • 06/04 (4-" -, oco� JEFFERSON C TY [l- 1)rIt • -, II �" L� �'r�' ` a DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend •Washington 98368 APR 1 0 1 li 360/379-4450 • 360/379-4451 Fax xqs 0 www.co.jefferson.wa.us/commdevelopment 81N . . , ,..v . .t ra Master Permit Application MLA: Project Description(include separate sheets as necessary): , aSo Gat- r (9IeopA , e_ (4nk ScdW or . , r>►e_Srze gnv._Loc2f Osil Tax Parcel c/ (� Property Number: I l v — q 00 - 0 0 Size: (acres/square feet) Site Address and/or Directions to Property: 53(0 OL4.th r." 6Lvc • P T. L+�1,13 Lnt„) on , Property Owner(s)of Record: ��fx ru 1 �l i � IA) b tip f Telephone: y'3 7 ' 13 1- 9 Fax: email: _ Mailing Address: 5 IT rE AppiicantiAgent(if different from owner): St-tiel S N [ I')e P C 0 p Telephone: ' .S S 7 c1 7 ('� Fax: _ email: Mailing Address: t't gS P_I o ( , r - c 6_ �p c.j` 0- - What kind of Permit?(Check each box that applies) ❑ Building I i Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit I I Conditional Use[C(a),C(d),or C]** ❑ Single Family I I Discretionary"D"or Unnamed Use Classification 0 Garage Attached/Detached i i Special Use(Essential Public Facilities)** ❑ Manufactured Home I i Boundary Line Adjustment ❑ Modular i! Short Plat** ❑Commercial* Li Binding Site Plan** ❑Change of Use i i Long Plat** ❑Address ❑ Road Approach a Planned Rural Residential Development(PRRD)IAmendments-* Propane ❑ Plat Vacation/Alteration** lowed"Yes"Use Consistency Analysis I 1 Shoreline Master Program Exemption/Permit Revisions** ❑Stormwater Management I l Shoreline Management Substantial Development** ❑ Site Plan Approval Advance Determination(SPAAD)* I I Shoreline Management Variance ❑Temporary Use I I Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* u 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: ' SIGNATIO GENT I h y '� „atct a gent ir....attc, ._a. ..is • Aor? erm'(s). T E ate: By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,isistie 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 Jefferson County and its employees,representatives or agents for the sole purpose of application review and a equired later ins ctions.Access nd right f entry to this property shall be requested and shall occur only during regular business hours. KSignature: '� Date: The acti 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 lake"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)evenjf- re in complian with the Jeff n Cou ty development core.The Applicant acknowledges that he,she or it holds individual and non-transfers a respo sibi• lying with the ESA. The Applicant has read this disc 'mer a d s' ns and dates it below. tet Signature;_ 7 .Date: ��z r a -, G:\Perini \FORMS\DRD FORMS\Master Pcmut Application 7-8-04.doc • OV7i*ER BUILDER STATEMENT A 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 MANUFACTURE OME INSTALLER: PHONE: FAx: (36o) .332.5S7F7 ( ) MAILING ADDRESS: I O r W YS 3 i 1 ,•- , EMAIL: CONTRACTOR'S LICENSE V WAINS NUMBER: S L.V 61 1)* 0 7 7 �,e NUMBER ARCHITECT/ENGINEER: / PHONE ( ) FAx:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: 0 New ❑ Wood Existing: ❑ Sewer Li Addition 0 Steei Proposed: Bank 0 Community System 0 Alteration/Remodel 0 Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# 0 Demolition ❑ Other: Bedrooms: Water Supply: Existing: _ Setback: ❑ Private well 0 Two Party Type of Heat: Proposed: C3 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: 11 Underground Tank KAbove ground Tank Size of Propane Tank: ca56 GA . l- Heat Stove i Cook Stove ❑ Woodstove El Fireplace Insert [I Hot Water Tank ❑ Pellet Stove ❑ 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: 2'9 Floor Base fee: , — 3' 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: $ Decks Receipt Number: Other Cash/Check Number: ,. ! ..,, ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and materials foundation to finish Initials: • PertnitCenter\FORMS\DM)FORMS\Muter Permit Application 7-8-04.doc