HomeMy WebLinkAboutBLD2007-00496 • •
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 #: BLD07-00496 Received Date 9/6/2007
SITE ADDRESS: 74 HAADA LAAS Issue Date 9/6/2007
PORT TOWNSEND, 98368
APPLICANT: GAIL E MACIEJEWSKI PHONE: 360-379-5759
74 HAADA LAAS RD
PORT TOWNSEND WA 98368
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 001062028 Section: 6 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, GAIL E MACIEJEWSKI PHONE: 360-379-5759
if different: 74 HAADA LAAS RD
PORT TOWNSEND WA 98368
PROJECT DESCRIPTION: 250 GAL.A/G PROP TANK& EXT. PIPE - NO MLA REQ'D
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 9/6/2008.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: 1a-jo-i_/pjri, 4INT1-ipi,L II-4,--07
FinalApproval 1‘-L -D7
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
UILDING PERMIT APPLICAT!N BRLDO7 00p496
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD07-00496 Received Date: 9/6/2007
SITE ADDRESS: 74 HAADA LAAS
PORT TOWNSEND, 98368
OWNER: GAIL E MACIEJEWSKI PHONE: 360-379-5759
74 HAADA LAAS RD
PORT TOWNSEND WA 98368
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 001062028 Section: 6 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 DESCRIPTIOI 250 GAL. A/G PROP TANK & EXT. PIPE - NO MLA REQ'D
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 2006 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:
Routing Date:
Type Amount Paid Bv: Date: Receipt: Approved/Date
Propane Tanks/Stoves $102.00 AMS 09/06/07 93179
Total: $102.00
111 •
SITE VISIT REPORT
(PLOT PLAN)
JOB DATE :
CONTACT:
ADDRESS PHONE #: •
DIRECTIONS FAX #:
Email
PLANNER:
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621 Sheridan Street • Port Townsend •Washington 98368 rrCCpp ```` A�N
360/379-4450 • 360/379-4451 Fax �E�fCRSOIr 4��'1l1 OD
qs0�p www.cojeffersonwaus/commdevelopment
Master Permit Application MLA:
Project Description(include separate sheets as necessary):
Tax Parcel Property
Number: 00 ( 0(, 2 0 8 Size: (acres/square feet)
Site Address and/or Directions to Property:
79 -AMA-4 A-- S , . p y r
Property Owner(s)of Record: r'iA !L /?' CI 'J ti S k/
Telephone: 3'7 e(- -S-7 S 7 Fax: email:
Mailing Address: s_S e—
Applicant/Agent(if different from owner): S U_MS H I K E P R_o P A N E
Telephone: 395-5717 Fax: 38S SS7S email: INFo@3un13N/NEPr'oPAr1C.
Mailing Address: I 0g53 RHODy D 2• / >a i NR-O t-ock, Li)A- 9 83.3
9 �rh
What kind of Permit?(Check each box that applies
❑Building ❑Variance(Minor, Major or Reasonable Economic Use)
El Demolition Permit ❑ Conditional Use[C(a),C(d),or C]**
Single Family 0 Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification
❑ Manufactured Home ❑ Modular 0 Special Use(Essential Public Facilities)**
❑ Commercial* 0 Boundary Line Adjustment
❑ Change of Use ❑ Short Plat**
❑ Address 0 Road Approach ❑ Binding Site Plan**
❑ Home Business 0 Cottagelndustry 0 Long Plat**
'f.Propane ❑ Planned Rural Residential Development(PRRD)/Amendments**
❑ Sign ❑ Plat Vacation/Alteration**
0 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
❑ Forest Practices Act/Release of Six-Year Moratorium ❑ Tree Vegetaion Request
*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:
l DESIGNATION OF AGENT
-J 'I hereby designate SU i•is H I NE PR-0P A to act as my agent in matters relating to this application for permit(s).
WNER$IGNATUR�, �'/ 4 /7`/; ,ve i tiV 1 1 (Date: `7
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.
\v 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. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the a plication hat he or she wants prior notice.
11 ignature: P •L.( /7�- � L�• (Date-7) 3/3//(07
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
\t 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-ransferable responsibility for adhering to an complying with the ESA. The Applicant has read this disclaimer and igns and dates it below.
', Signature: ��/L = 1( Date: bpi �67
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc