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HomeMy WebLinkAboutBLD2006-00192 !UILDING PERMIT APPLICATN BLD06-00192ReviewT Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00192 Received Date: 4/21/2006 SITE ADDRESS: 445 LARSON LAKE RD CHIMACUM, 98325 OWNER: GARY W USA PHONE: 847-223-9471 DONNA G USA 17 N LAKE AVE THIRD LAKE IL 600309011 MT TOWNSEND VISTA SUBDIVISION: Block: Lot: 20+ PARCEL NUMBER: 801105014 Section: 10 Township: 28 N Range: 01 W 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 DESCRIPTIOI` CHANGE OUT OF 250 A/G TANK TO 500 A/G TANK AND PIPING 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: Type Amount Paid By: Date: Receipt: Approved/Date Permit $51.00 LYK 04/21/06 80982 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 #: BLD06-00192 Received Date 4/21/2006 SITE ADDRESS: 445 LARSON LAKE RD Issue Date 4/21/2006 CHIMACUM, 98325 APPLICANT: GARY W USA PHONE: 847-223-9471 DONNA G USA 17 N LAKE AVE THIRD LAKE IL 600309011 20+ SUBDIVISION: MT TOWNSEND VISTA Block: Lot: PARCEL NUMBER: 801105014 Section: 10 Township: 28N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2006 OWNER, GARY W USA PHONE: 847-223-9471 if different: DONNA G USA 17 N LAKE AVE THIRD LAKE IL 600309011 PROJECT DESCRIPTION: CHANGE OUT OF 250 A/G TANK TO 500 A/G TANK AND PIPING 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 4/21/2007. REQUIRED INSPECTIONS: Tank/Line/Appliance: £AG„rigita L.o uL•L,ifie,74.0/06 FinalApproval: 4— L/& Lip)11 1\c-L1137 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 , • • SITE VISIT REPORT (PLOT PLAN) JOB Gp 65Y4 DATE : y 113 ( D_e . CONTACT: . ADDRESS PHONE #: . DIRECTIONS FAX #: . Email . U3 PLANNER: . o ,10 ZoD 6 z©mot , ,r- L9A „.\. t,) i ________ , / F �5-;111 CAS ,/ \ m ,' \ Q E \\ 0 c\ Apr-21-2006 11 :25 From- 411 4111 T-664 P 003/003 F-600 te"kiiiiyik JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT \\ --_,_-\°(\ 621 Sheridan Street• Part Townsend •Washington 88368 ,/� 360/379-4450 360/379-4451 Fax c----15 `b.' N 't° www.cP.jefferson.wa.us/cammdeveicrprnentn'j (3� Master Permit Application MI_A: Project Description(include separate sheets as necessary): p ���--'��� ckt,,, � Tax Parcel Property Number: PO ( / O 5 O( _ size. (aclnas/sgtrare feet) Site Address an<vor Directions to Property: `t< G AJ 1.--F1 K C !J / C l,�y7 _ Property Owner(*)of Record: Got-r''�l i 0a rZ n cs ti S A - Telephone: 73 a--- 0 7 e R - I Fax: - email: Mailing Address: 17 ►J. L--f)ke k rt-e. F J h i FZd K e - L L. q d u .LDS' Applicant/Agent(if different from owner): S 1-+-I S f--i r) e Fro f' ' Telephone: 3(a 0 3 4' ' S7 5 7 Fax: 'h O 3 e5 5 6'7-S email: Mailing Address:_[ U S ? had..., D r- P i—_ d j o� ai'�6 What kind of Perron?(Check oath box that applies) ID Building 0 Variance(Minor. Major or Raaaaonatale Economic use) o Demolition Permit 11 Conditional Use Pia). c(a),or cj w Q Single Family a Discretionary"D'or Unnamed Use Classification U Garage Attached/Detached LI Spaoal use(Essential Public Facilities)" .0 Manttfacturecl home U Boundary Line Adjustrnant 0 Modular ❑ Short Plat" 0 Commercial' 0 Binding Site Plan'* 0 Change Of LJse ❑ Long Plat" q Address ._ C Road Approach U Plsnnee Rural Residential Development(PIRRAYAmendments— tvprine 0 Plat Vacation/Alteration" ❑ lowed"Yes'Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions— o Stormwater Mapapsmsnt 0 Shoreline Management SwDttartlal Development o Site Plan Approval Advance Determination(SPAAD)' 0 Shoreline Management Variance A Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment 0 Wireless Telecommunication' Fl Jefferson County Shoreline Master Program Amendment to Forest Practices Act/Release at Six-Year Moratorium file r°gWre a Fri-Application Conference **Requires a OiaAppicatlan Conference Please Identify any other locale state or federal permits required far this proposal, If known: eIGNATIO- - GENT I It-. _•y •-•. /�� �j =•chi l e - -•• - -, 01:on - -(s). by signing this application horn.me ownerragent attests mat the Information provltlecl herein,and In any attachments,is.i eae aria comic!IA me bast of Ns,her ar It's lcnewleive. My matanal telsehood or any omission of a material fact made by me owner/agent wttn respect to this applicapan packet may result in Mils permit being null aril void- _ i flrmer Span to eartve,indemnity end hold haamte as Jefferson County agoln5t all Ilabllitla3S,lodgments,coon posts, rea9anaple attorney's tees ana expenses whkri may In any way accrue agairazt„ierfter'aan County as a result of or In consequence of Ilan grunting of[nib patina, I further aA►U id provide access and right of entry to.,Reason County and Its employees,raPresentatives or agents for the sore purpose of appiii=atirara review and any requr mar Inspections.Access an right of entry to ells property snail be requested and shall occur only during regular business noun. GT'li(A 9 oZf Signature: grate: The adton or actions Applicant will undertake as a newt or tine Issuance et this writ may negatively Impact upon one or more threatened or ermanpereatl species and could lead to a potential'take of an endangered apeoea as maw terms are defined In the federal law known as the TaKI4r189r903 Up•am Act or'ESA.'Jeff raon County Makes no assurances to rho applicant that Via ecUor+s that will Da undertaKen tivcaw"e thin permit has Wean issuer will not violate the ESA- My In0hrlduitl,group or atQency cast file a lawsuit an pahae at an enoangerecl spedes regarding your accion(s)even it you are in e:ompttanao%OM tnar Jefferson County development mode-Trim Applicant acme e0pes mat he.snar or It noIds in HO:Wei and non-trans res 'pon$lballry for a en to no mnlpry ing with me ESA_ The Applicent etas read this disclaimer end signs ono dares It wow.. signature: Dam- C/,L/- D9 G\PatniiCcua\FORMS\DRD FORMS\m she Prtnrrir Applecast n 7-2-O4.doc ;/� 1 6l"