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Home My WebLink AboutBLD2006-00259 RILDING PERMIT APPLICATPN BLRD06 00259 Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00259 Received Date: 5/16/2006 SITE ADDRESS: 173 NICHOLSMITH LN BRINNON, 98320 OWNER: RICHARD WHITE PHONE: 360-887-4988 JEANNINE C WHITE 21220 NW 31ST AVE RIDGEFIELD WA 986428523 SUBDIVISION: Block: Lot: T 33+ PARCEL NUMBER: 602231009 Section: 23 Township: 26 N Range: 02 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 DESCRIPTION WATER HTR, GENERATOR, & HEAT 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: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK. BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: 511(0 PO Type Amount Paid By: Date: Receipt: Approved/Date Permit $51.00 LYK 05/16/06 81347 Total: $51.00 0 07 1 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 #: BLD06-00259 Received Date 5/16/2006 SITE ADDRESS: 173 NICHOLSMITH LN Issue Date 5/16/2006 BRINNON, 98320 APPLICANT: RICHARD WHITE PHONE: 360-887-4988 JEANNINE C WHITE 21220 NW 31ST AVE RIDGEFIELD WA 986428523 T 33+ SUBDIVISION: Block: Lot: PARCEL NUMBER: 602231009 Section: 23 Township: 26N Range: 02W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP'077QP Expires 11/17/2006 OWNER, RICHARD WHITE PHONE: 360-887-4988 if different: JEANNINE C WHITE 21220 NW 31ST AVE RIDGEFIELD WA 986428523 PROJECT DESCRIPTION: WATER HTR, GENERATOR, & HEAT 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 5/16/2007. REQUIRED INSPECTIONS: Tank/Line/Appliance: 1-1,0hrt-K.- k' o6 vo_i..4 " 10 y ,,,,1 FinalApproval :2-1(p C 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 I �¢,SON codJEFFERSONN' �� DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax y �q�, p� www.co.jefferson.wa.us/commdevelopment • 8TN Master Permit Application MLA: (Jo VrtA ,-Eq1I d Project Description(incl de separate sheets as necessary): l,1) tOsite,r- /...4) ___#_eevr-S-itottte-.7,- Tax Parcel q Property Number: Co b a-- �- 3 ( O O 1 Size: (acres/square feet) Site Address and/or Directions to Property: 173 KIICE{OLSwl ITN LtJ grl/1 n on, cj/9 - Property Owner(s)of Record: ..* IC UAR o ! TCa.nni't e-• WAIT-t- Telephone: 3(QcD $$7 L0,38 Fax: email: Mailing Address: —2/ .1.2 O A)CA) 3/sr . /�/0 C:F/G L/J 43/9 . TjCP6/2-_ Applicant/Agent(if different from owner): Se(/'1J"ff/4/ p K o P/1r7 i__ Telephone: .36° - 3 8 S- 5'7 'T Fax: _ email: Mailing Address: j08J)----- --/' #o 07_P!' 6.) ( What kind of Permit?(Check each box that applies) u Fsuiidina ❑ Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit ❑ Conditional Use[C(a),C(d),or Cl** ❑ 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** 0 Address Cl Road Approach 0 Planned Rural Residential Development(PRRD)/Amendments** $ ropane ❑ Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions*'' ❑Stormwater Management 0 Shoreline Management Substantial Development** Cl Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Variance Cl Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium *Ma r-.uire a Pre-A•.lication Conference **R•.uire a Pre-A..lication Conference Please identify any other local, state or federal permits required for this proposal, if known: '''' SIGNATIO► s GENT y I he •- ,/ t . .• .gent i att- - al • - i IS • ' ..to•pn .er •(s). WI' O.TI � - - . �--- ��-e,ace, i By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is-trice and correct to the best of his,her or its 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 rntshty against al!liabilities,judgmuras,court ins,roaavi1abie atti.Aney's iees alit.; 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. //� / r Signature: /lticlik, 1.49 ly 64Lir Date: 9/-ZZ-e 1) � The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threaterjed ofvi I., endangered species and could lead to a potential'take"of an endangered species as those terms are defined in the federal jaw kr own 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 responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: X2 yy '� � Lr' _z( Date: Y—Zz-G -- i . 6\PermitCenter\FORMS\DRD FORMS\Mas.er Pemut Application 7-8-04.doc • UY►.lER 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: Sun Sfi/ Pr _ ( ) 38S 57 .7 ( ) MAILING ADDRESS: Q S EMAIL: CONTRACTOR'S LICENSE �7 . � NUMBER: WAINS Su hs 17L'-fia* 6 7 7 Q P NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: ❑ Addition ❑ Steel Proposed: ❑ Sewer ❑ Ae inNRemodel Bank ❑ Community System ❑ Concrete Total: Height: ❑ Repair ❑ Masonry ❑ Individual System •,-_ SEP Permit rrrtit# _ Existing: `titer Supply: Type of Heat: Pro Setback: ❑ private well ❑ Two Party posed: Total: Li Public — — I Name of System: I 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 IBC Occupancy: IBC Type of construction: Proposed If this is a Propane Tank and/or Appliance Installation permit,mark all items e ow that pp ill you have y.Service? Yes / No I Underground Tank Li Above ground Tank Size of Propane Tank: Heat Stove ❑ Cook Stove Li Woodstove Li Fireplace Insert ? Hot Water Took ❑ Pellet Stove Other Is this appliance being installed in a Manufactured/Mobile Home? Yes / L_ SS '�' When applying for a permit to install a propane tank you must also submit a site plan showingp�sg, �� lines, tank location and size,distances from the propane tank to all property lines,buildings and septic system components,all pen includin• the reserve area. S•uare Footage For Office Use Only , • Current Pro•osed Main Floor Amount' Consistency Review: 2 Floor ---_ Base fee: 3r°Floor --— - -- _ Additional Section: Mezzanine: Plan Check fee: Heated Basement State Surcharge fee: Unheated Basement Pot Water Review tee:Other Unheated 911/Rd Approach fee: Garage/Carport — -- -- — • ~Decks — ---� - — TOTAL: $ IReceipt Number: . • Other - t_.___-.-_--.__ • i Cash/Check Number -- ESTIMATED COST(REQUIRED) Date: *Fair market value of all labor and materials founaation to finish Initials: —. i \PermitCenter\FORMS\DRD FORMS\Master Permit Applicauu,,7-8-O4.doc