HomeMy WebLinkAboutBLD2006-00523 • •
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 #: BLD06-00523 Received Date 9/12/2006
SITE ADDRESS: 220 SHINE RD Issue Date 9/12/2006
PORT LUDLOW, 98365
APPLICANT: THOMAS H GISKE PHONE: 411A - (0-79 - 1031A
FLORENCE A GISKE
6517 CYPRESS POINT DR
PLANO TX 750938812 4+
SUBDIVISION: R SHAW SHORT PLAT Block: Lot:
PARCEL NUMBER: 821333023 Section: 33 Township: 28N Range: 01 E
CONTRACTOR: WHITEY JOHNSON GENERAL CONTR PHONE: (360)779-9884
PO BOX 1110
SUQUAMISH WA 98392
f 33Bg0o) 5��8 3308
Contractor's License WHITEJG95 2DN Expires 3 15/20
OWNER, THOMAS H GISKE PHONE:
if different: FLORENCE A GISKE
6517 CYPRESS POINT DR
PLANO TX 750938812
PROJECT DESCRIPTION: NO MLA - 100 GALLON A/G PROPANE TANK
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 9/12/2007.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: /110e DID 9/Z9‘ Lwo ra 6ENE,eivrat V204,
FinalApproval: e/ -12,Y /z(ôt/(
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
BUILDING PERMIT APPLICATItN BLD06-00523
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD06-00523 Received Date: 9/12/2006
SITE ADDRESS: 220 SHINE RD
PORT LUDLOW, 98365
OWNER: THOMAS H GISKE PHONE: 972-679-1034
FLORENCE A GISKE
6517 CYPRESS POINT DR
PLANO TX 750938812 R SHAW SHORT PLAT
SUBDIVISION: Block: Lot: 4+
PARCEL NUMBER: 821333023 Section: 33 Township: 28 N Range: 01 E
CONTRACTOR: WHITEY JOHNSON GENERAL CONTR PHONE: (360)779-9884
PO BOX 1110
SUQUAMISH WA 98392
Contractor's License WHITEJG952DN Expires 3/15/2007
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr NO MLA - 100 GALLON A/G PROPANE TANK
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: T -
Routing Date:
gI ►31a0
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $51.00 DJK 09/12/06 85003
Total: $51.00
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Telephone: q -7 9 7 t� Fax 47 _---ice ertwa
Mailing Address: _4_ j-7 <iY p r e •,
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Matlnp Address: ��� �9f3 �3r�� snail:
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a e�of Permit?(puc(each box that applies)
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011A 0 Spe„dat Use l sse Public Use
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0 S0"""�' 0ShortPrat•• uetrnertt
Change of Use 0 Dimling&to Plan»
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Amendment
a t oUeCAand District!dap For•
est t'"ci°°s .AWRa1� earls of 3ix�Y � 0 �'^County Shoreane Master Program 't
Pleas.Identify any other local.state or federal permits required for Ulla per,If
I hereby terse ',x'7'''r • OF AGENT
/�;.� - of .. ..../, b ad es my in mad
X Owhen SOrrATURE �//L,//Lr 7,,1_ ers relating b Ws bon for permits).
er Date i
her*wow Nsalplkadn,•taro,s,e c qu,nh,0,nt eMasei trgt the a
�y result 1n knowledge.o pe,n malarial falsehood or am art�lKar�of maonprovichsd de t �Y Nbd+rrue,rts.k eve and port std m the bast d
null and volt
I rotator wee b save.Indeneyn,and trirld hamlets °M"�+t with pep to San��'p'�
egarinst
t Curlier agree animated'AIM any in any accrue against Ow*et Cora*r w«r'IIv`'a►ence of:Dour opt,reasonable+Aion+sys Ifeea and
rwtaw aria any b�a eaoeoa end npht4f eeby e, •„ consequence e(lhe d e,th pent*.
hours hepeflfeas.Aare and pea owtnrrt be requested
representatives or opener b►the sale pwpooe of svyitmtai
b end sNM Dope
�rptakee: �' «'lr bWbrass
Distfr
7ne soon or acsons Applicant sat undertake to lasuarice
Ns
etigengenig
species and case Med to a aOY1�,ske"e remitof of penult may ;sad in th ehe's a mole;taw known s t e
"Endangered parses Act Of�it I •Jefferson en B1 °fn species as Lose saint*eor
defined action(a)avers • age
Penni has been Wend
••war not Nei.' the Mma esai,110 a 4 the atolcont that the slovens behalf,a at wet n artokoa know►as
art, ' Wm tlo.ktferson ►. or hipa,r t can h a tawaidt on e Aiolicart knowl elan e s holds
Nbecause du
X Signature: r �i% adtrsw.p b ar� Me ESII The MPra ,4h •isttra,she a p bards lour
`�� /�� si�arid dales t1 below_
c: Ptanik ntetwoxa stoma Pakike1M ester re.ro. ion 1 -- - _ �`
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1 i SEP 1 2 2006
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DEPT. O
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The signer of this statement does hereby certify that they are the Owners n the parcel referenced herein,that they are not licensed contractorAnd that
they will be assuming the responsibility of the General Contractor for the proposed project.
Signature: Date:
GENERAL CONTRACTOR PHONE: FAX:
I,l)q I rim I r-},tic;-/ v— PJ- C ci 0-1- . 1 ii) ( [.,o) 11 i `f a; {- e j2c3) GQ -2,
ILm MAG ADDRESS: V'J en,..L. i i 1 04_1 :,f CX',rtli(�i-1 \l) Ewa': `
CONTRACTOR'S LICENSE WAINS
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NUMBER: (,��f{-i rT= ,i s 4��nrJ NUMBER 60 2 ��� '!
ARCHITECT/ENGINEER: Prot ( ) FAX ( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New fir Wood Existing: a 0 Sewer
34 Addition 0 Steel Proposed: t Bank 0 Community System
❑ Alteration/Remodel ❑ Concrete Total: 4- Height 0 Individual
❑ Repair ❑ Masonry 1 b' 4Vc(es_. SEP Permit#Sy A-17y
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well 0 Two Party
Type of He Proposed: '0 / / ,Pc Public
Q, , n �t Total: -— __-7 Name of System: Rt Ll ti-
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(uidudes owners,tenants,employees,etc) Current Proposed
IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No
If this is a Propane T k and/or Appliance Installation permit.mark all items below that apply: +
❑ Underground Tank 6, Above ground Tank Size of Propane Tank: I•?,cam (-rt -- C S1—C-r
❑ Heat Stove 0 Cook Stove 0 Woodstove A Fireplace Insert ❑ Hot Water Tank 0 Pellet Stove f Other FL( A r-
Is this appliance being Installed in a Manufactured/Mobile Home? Yes /*
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 o Use Only - f
Current Proposed lou'U.._: -_2
Y; _
Main Floor � � Review�w '
I�+ I ( �
• Floor l, 3--:'9 i aro' DI I
i<
::4:-. ::
e'7 i e Section:
OCT� •�
Mezzanine: Pla� « 1p. . OC 1 �5." r s C..
Heated Basement ;,` } .: U� 1 • �4:
Unheated Basement Pot rRoviewfee
3 'r
+'y ' 4� f1 co
Other Unheated i✓ -2-rrC> : 9lllRd Approach fee F ,
Ga e/Ca rt `,7 /0 2-$ 1 aC T TOTAL: $ 1 r
i
Decks - No r /1 1
Other j Check Number: (;t
ESTIMATED COST(REQUIRED) j �` ' i
*Fair market value of air labor and materials fioundatior, p h "�' / b
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