The URL can be used to link to this page

Home My WebLink AboutBLD2006-00704 • • 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 #: BLD06-00704 Received Date 12/18/2006 SITE ADDRESS: 212 N ANDREW AVE Issue Date 12/18/2006 PORT TOWNSEND, 98368 APPLICANT: VICTORIA MANSFIELD PHONE: 379-1719 181 MADRONA TERRACE SEQUIM WA 98382 39-43 SUBDIVISION: IRONDALE Block: 142 Lot: PARCEL NUMBER: 962114213 Section: 35 Township: 30N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2008 OWNER, VICTORIA MANSFIELD PHONE: 379-1719 if different: 181 MADRONA TERRACE SEQUIM WA 98382 PROJECT DESCRIPTION: NO MLA REQ'D Installing gas pipe to gas range 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 12/18/2007. REQUIRED INSPECTIONS: `C�� Tank/Line/Appliance: . ,/<- i1 4 fps FinalApproval: I `Z-2 -7 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 111kJILDING PERMIT APPLICA1N BLD06-00704 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00704 Received Date: 12/18/2006 SITE ADDRESS: 212 N ANDREW AVE PORT TOWNSEND, 98368 OWNER: VICTORIA MANSFIELD PHONE: 379-1719 181 MADRONA TERRACE SEQUIM WA 98382 IRONDALE SUBDIVISION: Block: 142 Lot: 39-43 PARCEL NUMBER: 962114213 Section: 35 Township: 30 N Range: 01 W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2008 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION NO MLA REQ'D Installing gas pipe to gas range 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: 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: Type Amount Paid By: Date: Receipt: Approved/Date Permit $51.00 DJK 12/18/06 86846 Total: $51.00 �O1V i 6 JEFFERSON�UNTYW &D 0(,- �- ��` 4 DEPARTMENT OF COMMUNITY DEVELOPMENT J!CE WE E) 621 Sheridan Street • Port Townsend •Washington 98368 �. 360/379-4450 . 360/379-4451 Fax DEC 18 2006 gS,�N�,sO www.co.jefferson.wa.us/commdevelopme�nt (� n' Master Permit Application ,JEF, ��IIIINIV II''1 No MLR L Project Description(include separate sheets as necessary): y C 91 P/P(5.- %c /2_4-7-7 6-C_ Tax Parcel /,;�� //� �/>� Property Number: j Size: (acres/square feet) Site Address and/or Directions to Property: a / "a- Al , .e---) / o I.-)1 f e-vvyJ r Property Owner(s)of Record: V/L TO/L/ /it /Y(AY/.; ,C, a72_/9 Telephone: 3 7 57 i 7 ( �j Fax: email: Mailing Address: --5- � _ Applicant/Agent(if different from owner): _ SZ' J7 //\/ e rveoP/9-Al q Telephone: 3 eS S`-S 7 Fax: ,F g 3---,5e 7S email: /A/FOr .TLf,/.9///'IC._pl0//74e . Mailing Address: / O Pc tetL-DO c/ ,CAR. P -, V'77 LZI C/c 4-. .Fc' qi F cow ,What kind of Permit?(Check each box that applies) U Building ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit ❑ Conditional Use[C(a), C(d),or C]** ❑ Single Family 0 Discretionary"D"or Unnamed Use Classification ❑ Garage Attached/Detached ❑ Special Use(Essential Public Facilities)** ❑Manufactured Home ❑ Boundary Line Adjustment ❑Modular ❑ Short Plat** 0 Commercial* ❑ Binding Site Plan** 0 Change of Use 0 Long Plat** ❑Address 0 Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** g Propane ❑ 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 ❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment 0 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: �. SIGNATIO GENT I he ct as y� at � gent„ip att a n. r. is .,: '.':,ion (s), r E G ate: 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 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 Offe on County and its employees,representatives or agents for the sole purpose of application review and an required later ins ' s.Acce nd r.h of entry to this property shall be requested and sh occur only during regular business 111 hours. `� Signature: 1 'I I V(, Date: d I �/'V J 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"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 • \5permit 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)eve if you are in complia with the Jeffe •n f5 unty development code.The Applicant ackno ges that he,she or it holds individual and non-tra s ra ponsibi( for dherin to a . . lying with the ESA. The Applicant has read thi d claimer and signs and daG it below. � 1, Signature: \\ Date: ` G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc • OWNER BUILDER STATEMENT III 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 buss ing the r n ibility artA G ra�l Contractor for the proposed p ie Signature:` Date: . ,-1 / , GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: Suh Shl-/AiE ,02 0 A-t-1 € (360) 3 8S-s 797 (366) 3BS- S?7S MAILING ADDRESS: / Q 0 .S y 0? / v C l' EMAIL: I n Fo 5q is7//n e PRop -rte . c.O/t1 CONTRACTOR'S LICENSE ` WAINS NUMBER: S Cf ti sIf-10 7K 07 7 QZ P NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAx:( ) - MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System O Alteration/Remodel ❑ Concrete Total: _ __ Height: ❑ Individual System O Repair ❑ Masonry SEP Permit# O Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well 0 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 ❑ Above ground Tank Size of Propane Tank: EI Heat Stove ook Stove ❑ Woodstove 0 Fireplace Insert ❑ Hot Water Tank 0 Pellet Stove -` 1 Other 64 (2 Is this appliance being installed in a Manufactured/Mobile Home? Yes / No l/ 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 I { F .�x Current Proposed l Amount = Nh 3 i` Main Floor Consistency Review: • �c• 2ND Floor Base fee: di, ti j ' 3�Floor Additional Section: • Mezzanine: Plan Check fee: Heated Basement State Surcharge fee: j, .a .k s x,. = „ ,. ,, :',„ Unheated Basement Pot Water Review fee; Other Unheated 911/Rd Approach fees ' _ .- Garage/Carport TOTAL: $, Decks Receipt Number: Other Cash/Check Number: `°` : :4'i '•„� ti � ,m w n ESTIMATED COST(REQUIRED) Data: - � .Fair market value of all labor and materials foundation to finish 1 • i.i4" Initials: ,,, G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc