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HomeMy WebLinkAboutBLD2006-00280 PILDING PERMIT APPLICATIJ BL v Reviewiew T Ty280 ype: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00280 Received Date: 5/22/2006 SITE ADDRESS: 55 MCKENZIE LN PORT LUDLOW, 98365 OWNER: DONALD E PLORDE TRUSTEE PHONE: 360-437-5071 ROSALIND K PLORDE TRUSTEE 55 MCKENZIE LN PORT LUDLOW WA 983659233 TIMBERTON VILLAGE PHASE I SUBDIVISION: Block: ? Lot: 5 PARCEL NUMBER: 998500005 Section: 17 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 120 GAL PROP TANK, GAS INSERT & GAS PIPE 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: RoouutingDater Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $51.00 LYK 05/22/06 81363 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 #: BLD06-00280 Received Date 5/22/2006 SITE ADDRESS: 55 MCKENZIE LN Issue Date 5/23/2006 PORT LUDLOW, 98365 APPLICANT: DONALD E PLORDE TRUSTEE PHONE: 360-437-5071 ROSALIND K PLORDE TRUSTEE 55 MCKENZIE LN PORT LUDLOW WA 983659233 5 SUBDIVISION: TIMBERTON VILLAGE PHASE I Block: ? Lot: PARCEL NUMBER: 998500005 Section: 17 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, DONALD E PLORDE TRUSTEE PHONE: 360-437-5071 if different: ROSALIND K PLORDE TRUSTEE 55 MCKENZIE LN PORT LUDLOW WA 983659233 PROJECT DESCRIPTION: A/G 120 GAL PROP TANK, GAS INSERT& GAS PIPE 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 5/23/2007. REQUIRED INSPECTIONS: Tank/Line/Appliance:j'FIA9 ter T /per Dk 7�1 , <i(>? ,c, - 1/2//04 d! FinalApproval: OK -07r 41 z/zgfr 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 pop a- �Oz- DLO P�� DATE : S/0/ /0 eo CONTACT: ADDRESS PHONE #: DIRECTIONS FAX #: Email PLANNER: rK MAY 222L": c \ S 5' • 6 O J p�� r ti V 4SpN eo6, JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: Project Description(include separate sheets as necessary): 4 Tax Parcel 1 9 ? 500 00 D O s Property Number: Size: (acres/square feet) Site Address and/or Directions to Property: 55 Pi KeN1 i'e, L-14 PT • L'-t-Oi-off 1J l'9- 9d 3 Property Owner(s)of Record: J)v t' t o-z- EL O,A D E Telephone: 3 f• S 0'7 i Fax: email: Mailing Address: S Applicant/Agent(if different from owner): SL.h r H-I n e P 12_o p Arn Telephone: 3 8S -S 7 5 7 Fax: email: Mailing Address: I 0? 5 3 ‘.t1-.\ Cr pT �Si_ft,ALL L.)c. 4Z)3`i 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 CI** ❑ Single Family ❑ Discretionary"D"or Unnamed Use Classification ❑ Garage Attached/Detached ❑ Special Use(Essential Public Facilities)** ❑ Manufactured Home ❑ Boundary Line Adjustment 0 Modular ❑ Short Plat** ' ❑Commercial* ❑ Binding Site Plan** ❑Change of Use ❑ Long Plat** ❑Address 0 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 0 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 0 Forest Practices Act/Release of Six-Year Moratorium *Ma r uire a Pre—A lication Conference _ **Requires a Pre-Application Conference Please identify any other local, state or federal permits required for this proposal, if known: SIGNATIO GENT I he y d s' at ct as iagent ip att- ;a:e a r • : is . 'w.j ion : •- (s). AT E l : By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,istrde 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 al 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 any require ater inspecti s. ccess a right of entry to this property shall be requested and shall occur only during regular business hours. f!i Signature: _ Date: V CJ 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 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)even if you are in compliance with the erson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferabl ponsibility f g to nd complyjpg with the ESA. The Applicant has read this disclai er and suns and dates it below. Signature: K Date: (.5 Ql���� G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc • • OWNER 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 PHONE: FAX: S'VuLA.,5 t+u- P c'CID 0--r--Q-___ ( 3 Lb ) 3 YS-5717 ( ) MAILING ADDRESS: i p g•53 4 Avz. 0 r EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: S to h S H-'IO r�b 1 r) Q P NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: 0 Sewer ❑ Addition ❑ Steel Proposed: Bank 0 Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ Repair 0 Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: 0 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: • _ ❑ Underground Tank XAbove ground Tank G�5 Size of Propane Tank: ;"'©1-v vh r,i., ❑ Heat Stove ❑ Cook Stove ❑ Woodstove $ Fireplace Insert [l Hot Water Tank Li Pellet Stove ti,Other G.y) I° Is this appliance being installed in a Manufactured/Mobile Home? Yes / No 6 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: -, 2N0 Floor Base fee:(—) c,y 3t°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: $ , i'1 , ,/ Decks Receipt Number ` z Other Cash/Check Number: '„ 14,,, I ESTIMATED COST(REQUIRED) Date: 7` •Fair market value of all labor and materials foundation to finish Initials: _ G:\PecmitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc