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Home My WebLink AboutBLD2006-00630 QUILDING PERMIT APPLICA!ON BL Revviewiew T Ty630 ype: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00630 Received Date: 11/3/2006 SITE ADDRESS: i5aLUNA CT QUILCENE, 98376 OWNER: LEE EMOND PHONE: 1-530-409-1627 RAVEN EMOND 3126 ROOSEVELT ST PLACERVILLE CA 95667 SUBDIVISION: Block: Lot: PARCEL NUMBER: 501032027 Section: 3 Township: 25 N Range: 01 W CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/7/2008 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION NO MLA REQ'D INSTALLING A/G SO )GALLON 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: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $51.00 DJK 11/03/06 85200 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 #: BLD06-00630 Received Date 11/3/2006 SITE ADDRESS: I5�.LUNA CT Issue Date 11/3/2006 QUILCENE, 98376 APPLICANT: LEE EMOND PHONE: 1-530-409-1627 RAVEN EMOND 3126 ROOSEVELT ST PLACERVILLE CA 95667 SUBDIVISION: Block: Lot: PARCEL NUMBER: 50103202 7 Section: 3 Township: 25N Range: 01W CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/7/2008 OWNER, LEE EMOND PHONE: 1-530-409-1627 if different: RAVEN EMOND 3126 ROOSEVELT ST PLACERVILLE CA 95667 PROJECT DESCRIPTION: NO MLA REQ'D INSTALLING A/G 5 (GALLON 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 11/3/2007. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: L I( eleq 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 Map Output Page 1 of 1 • • ArcIMS HTML Viewer Map 931032CX10 50403203' 60*,32032 60/032033 ...Glen Dr cAJ --.. iX..• i.s 6 601032020 Legend i % CD Selected Features a 4) p- Towns G 3 CD I#� Cart Sag76�� L * Rf�^a Cutkx, 60,032002. 50/032027 -4 JC Roads Pa rc,e is-H Boundaries ( , Oc)QO2 i/rYC2O22 Llama:7a:..clod 34.-v.crt,-,r vrnY Gent;xrru:xt"4S f?MINSEMESSMNIMEMMIn 237#t FOR INFORMATIONAL PURPOSES ONLY- Jefferson County does not attest to the accuracy of the data contained herein and makes no warranty with respect to its correctness or validity. Data contained in this map is limited by the method and accuracy of its collection. Tue Nov 25 12:57:54 2008 http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&ClientVersion=... 11/25/2008 • • 4.i)¢S0N Cb& JEFFERSON COUNTY RErgivE10 W q,,` A DEPARTMENT OF COMMUNITY DEVELOPMENT t ' = `'4 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax NOY 0 3 a www.co.jefferson.wa.us/commdevelopment ll nn''11 V11f� Is tINO's° dL1 bW1N 1 UI,O Master Permit Application MLA: iEF Project escri tion(iiiclude separate sheets as cessary): Tax Parcel 3 Property / r Number: D 0?-7 Size: , f.cre--j (acres/square feet) Site Address and/or Directions to Property: Lt— L,•,U t•1 Property Owner(s)of Record: -.) -1 l Telephone: — Fax: email: Mailing Address: ' Applicant/Agent(if different rom owner): Telephone: Fax: email: Mailing Address: , , hat 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 C]** d Single Family ❑Discretionary"D"or Unnamed Use Classification ❑Garage Attached/Detached ❑Special Use(Essential Public Facilities)** Q Manufactured Home °Boundary Line Adjustment El Modular °Short Plat** ❑Commercial* °Binding Site Plan** 0 Change of Use ❑Long Plat** WQ ddress i Road Approach °Planned Rural Residential Development(PRRD)/Amendments** ropane ❑Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis ❑Shoreline Master Program Exemption/Permit Revisions** ❑Stormwater Management ❑Shoreline Management Substantial Development** ❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Variance ❑Temporary Use ❑Comprehensive Plan/UDC/Land Use District Map Amendment OWireless Telecommunication* °Jefferson County Shoreline Master Program Amendment ❑Forest 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 req, red 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 appli ' n that h he rior notice �/� y Signature: Date: I/ J�41 2_60�The action or act* ns Applicant will undertake �id�' pp as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered spe ies 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 yod'are in compliance wit b Jefferson County development code.The Applicant acknowledges that he,she or it holds individual 'Xi and non-transfer fe responsi i4ity for a en to and complying with the ESA. The Applicant has r ad this disci imer and signs and dates i below. Signature: A,, .r e •C Date: // --2 O 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 assuming the responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: G S (3e0)7 3a — 95.85— ( ) MAILING ADDRESS: P .0 ,�(tcry la1 S 1 S? - rumi toyir EMAIL: CONTRACTOR'S LICENSE V ) I eip.�' WAINS NUMBER: G 14 S T im�/ 9-7 9 02 l NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Prelect Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ew 0 Wood Existing: ❑Sewer ❑ Addition 0 Steel Proposed: Bank ❑Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: I Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Su Existing: Setback: Supply: Type of Heat: Proposed: 0 PuPrivate well ❑ Two Party Total: - Name of System: 0 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 jbove ground Tank Size of Propane Tank:_4 5 i) 7 UiJ- °Heat Stove 0 Cook Stove ❑Woodstove ❑Fireplace Insert ❑Hot Water Tank 0 Pellet Stove Other e 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 Bld App Review: 2nd Floor Heated Consistency Review: //�� -S• SV Other Heated Base fee: SI - 00 Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: /� Other 1� L id e�G-1 TOTAL: $ --)CI. So / J,611.4 1--'1 Receipt Number: Q 500 0 Cash/Check Number: Q" 2 05- ESTIMATED COST(REQUIRED) Date: ' '3•DC) - �\ - Or 'Fair market value of all labor and materials foundation to finish to Initials: \C., \/ D:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05-2.doc