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Home My WebLink AboutBLD2006-00425 el ILDING PERMIT APPLICAT N BLD06-00425 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00425 Received Date: 7/21/2006 SITE ADDRESS: 7512 SR 20 PORT TOWNSEND, 98368 OWNER: JOYCE A HAWKINS PHONE: 360 379-2956 7512 HWY 20 PORT TOWNSEND WA 98368 SUBDIVISION: Block: Lot: + PARCEL NUMBER: 001282009 Section: 28 Township: 30 N Range: 01 W CONTRACTOR: EVERWARDS HEARTH & HOME 257151 HWY 101 PHONE: 360-452-3366 PORT ANGELES WA 98362 Contractor's License Expires 08/17/2006 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr New Wood Stove, 120 A/G Propane Tank & Cook Stove 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 Bv: Date: Receipt: Approved/Date Permit $51.00 KAS 07/21/06 83739 APPROVED Total: $51.00 �/ JUL21)2006 Jefferson County Planning & Building Department • • 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 #: BLD06-00425 Received Date 7/21/2006 SITE ADDRESS: 7512 SR 20 Issue Date 7/21/2006 PORT TOWNSEND, 98368 APPLICANT: JOYCE A HAWKINS PHONE: 360 379-2956 7512 HWY 20 PORT TOWNSEND WA 98368 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001282009 Section: 28 Township: 30N Range: 01W CONTRACTOR: EVERWARDS HEARTH & HOME PHONE: 360-452-3366 257151 HWY 101 PORT ANGELES WA 98362 Contractor's License Expires 38/17/2006 OWNER, JOYCE A HAWKINS PHONE: 360 379-2956 if different: 7512 HWY 20 PORT TOWNSEND WA 98368 PROJECT DESCRIPTION: New Wood Stove, 120 A/G Propane Tank& Cook 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 07/21/2007. REQUIRED INSPECTIONS: Tank/Line/Appliancej.-AJT LiN�E �f-9-�� (.A:900.6T VithZ4.0. 01E --E-2'—<c FinalApproval: i5-i9'7 BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIC Office Hours 9:00 a.m. -4:30 p.m. HOT LINE AVAILABLE 24 HOURS A DAY I:\F_BLD_Permit_Propane.rpt 10/29/19c ON C,o6 • • may` ROT ' 4 DEPARTMENTN OFCOUN COMMYTY DEVELOPMENT � '' '� 621JEFFE SheridanS Street • Port TownsendUNI E. Washington 98368 360/379 4450 • 360/379-4451 Fax L �SBrrraz° www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: Pro'ect Description(include separate sheets as necessary): Tax Parcel / / Property Number: L. " ,7 6 c2- -'D 9 Size: °>1 3 (acres/square feet) Site Address and/or Directions to Property: �� f�.ry J d r.a4,%ays-r,.� y/ 9, /. .'_3 E 6 Property Owner(s)of Record: d d e. e 4. 1 1-XC, "7 s Telephone:(?4:J ,5 2'-;3%-5 '4 Fax: email: Mailing Address: S/r)- /A 'y J G �0 2 T jar✓n surd j i'V J 73 6 F Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: W kind of Permit?(Check each box that applies) uilding ❑Variance(Minor,Major or Reasonable Economic Use) d Demolition Permit ❑Conditional Use[C(a),C(d),or C]** Cj Single Family ❑Discretionary"D"or Unnamed Use Classification El Garage Attached/Detached OSpecial Use(Essential Public Facilities)** El Manufactured Home °Boundary Line Adjustment CI Modular OShort Plat** El Commercial* °Binding Site Plan** 0 Change of Use °Long Plat** Q Address i 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 ❑Shoreline Management Substantial Development** OSite Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Variance OTemporary Use ❑Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* °Jefferson County Shoreline Master Program Amendment OForest 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: DESIGNATION OF AGENT I hereby designate to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: 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. Staff's access and right of entry will be assumed unless the applicant informs the County in writing at the time of the applicaf that he or she wants prior notice. t Signature: f -Z7ci— ��. /64' ' 7 �/u 9- /, Date: 7// f/�� The action oractior>sApplicant 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"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 responsibility for adhering to and co Icing with the SA. The ant has read this di ai er and s' ns and dates it below. Signature: 1-C L/� f,�-,;� .-T iZ/� Date: I /7 (r C _, Iv D:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05-2.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 ass ing the respon ility of h eneral Contractor for the proposed project. /� Signature: _ . t/� Date: 7 ��`- .2co to GENERAL CONTRA R OR MANUFACTURED HOME INSTALLER: PHONE: FAX: -vEY', /Atar 1 ti rt-Ws 2- HOn E ) 1IS2 33C4 ._45a-67 MAILING ADDRESS: .57(v' H�v CONTRACTOR'S LICENSE y� Op'9 y�, r�� WAINSI NUMBER: V I.•J\ �V S �` OW 4 V'V L- NUMBER ARCI IITCCT/CNeI PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: ❑Sewer ❑ Addition 0 Steel Proposed: Bank 0 Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: 0 Private well 0 Two Party Type of Heat: Proposed: ❑Public Total: Name of System: 0 If this is a Commercial Protect 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'Above ground Tank Size of Propane Tank: ❑Heat Stove%Cook Stove KWoodstove ❑Fireplace Insert 0 Hot Water Tank ❑ Pellet Stove p 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 Current Proposed For Office Use Only Amount Revision Main Floor Heated EH BId App Review: 2°d Floor Heated Consistency Review: f).5C) Other Heated Base fee: 5 . 00 Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Decks -- 't- 911/Rd Approach fee: Other t, r TOTAL: $ i Receipt Number: C63-111 Cash/Check Number: a a,1 ESTIMATED COST(REQUIRED) Date: IaI C a .Fair market value of all labor and materials foundation to finish 10 Initials: D:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05-2.doc o • t...... ; 1 1 S-' . . 4. ■_ •E •--- --_ -- �.r - - - - - o ,11111r1: :.a ■ — 1 _ _ - .9 0 -- --- - -- - tn `"� -111111111 -- -- -- -- - -- - IL _ _ __ - i_ Ili ,„„„, , _ . ,,..i ___ ____________ , ,,,. ,._ 1 i _ _ __. ._____,., _____ _ fl . . 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