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Home My WebLink AboutBLD2009-00021 OBUILDING PERMIT APPLICAMON B RD09 00eview 0e21 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD09-00021 Received Date: 2/2/2009 SITE ADDRESS: 5291 CAPE GEORGE RD PORT TOWNSEND, 98368 OWNER: PATRICIA G WEEDMAN PHONE: 360-379-8161 2023 E SIMS WAY PORT TOWNSEND WA 98368-6905 OCEAN GROVE ESTATES SUBDIVISION: Block: 1 Lot: 7 PARCEL NUMBER: 977100106 Section: 24 Township: 30 N Range: 02 W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2010 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION SWAP OUT 250 GAL PROP TANK - SAME SIZE & LOCATION - NO MLA REQ'D TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION MAIN: CODE EDITION: 2006 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 Total: • 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 #: BLD09-00021 Received Date 2/2/2009 SITE ADDRESS: 5291 CAPE GEORGE RD Issue Date 2/2/2009 PORT TOWNSEND, 98368 APPLICANT: PATRICIA G WEEDMAN PHONE: 360-379-8161 2023 E SIMS WAY PORT TOWNSEND WA 98368-6905 7 SUBDIVISION: OCEAN GROVE ESTATES Block: 1 Lot: PARCEL NUMBER: 977100106 Section: 24 Township: 30N Ranqe: 02W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 13$5-1/17 2010 5875 Contractor's License SUNSHP*077QP Expires 1 I / IO OWNER, PATRICIA G WEEDMAN PHONE: 360-379-8161 if different: 2023 E SIMS WAY PORT TOWNSEND WA 98368-6905 PROJECT DESCRIPTION: SWAP OUT 250 GAL PROP TANK -SAME SIZE & LOCATION - NO Directions MLA REQ'D To Site: 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 2/2/2010. REQUIRED INSPECTIONS: ank Line/Appliance: Fin alApproval:: [4j) 1.—,P i0/9,1 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 �gON C • • 1 4 �� JEFFERSON COUNTY ti iq r} DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax 1.6.-rliNG` p www.co.jefferson.wa.us/commdeveloagtent2 Z039 Master Permit Application MLA: 00 MLA 1 Project DesOption(include separate sheets as nec= � r / t/S/k/7) 2-06/rbzwi Tax Parcel / 0 / Property Number: / / d 6 Size: (acres/square feet) Site Address and/or Directions to Property: .5c.2 9/ C C / , Property Owner(s)of Record: G-�/'J GL�b J P e 62--i?z o, - 1 Telephone: 37 9- O 'l� - Fax: email: Mailing Address: 0 02 L . S//!1S' W AY Pr. / 0Wr, Applicant/Agent(if different from owner): S(4-.MS I P Ro A N E Telephone: 395-57 9 7 Fax: 38S' SS 7S email: N cG SuAi3N/NE proems(°, Mailing Address: I OB53 RooDy D 2 • f i. Hicto Lock LJ R- 9 83.E cool What kind of Permit?(Check each box that applies ❑Building 0 Variance(Minor, Major or Reason ble Economic Use) ❑ Demolition Permit ❑ Conditional Use[C(a), C(d),or C],* Single Family ❑ Garage Attached/Detacned U Discretionary"D"or Unnamed Use�Classification ❑ Manufactured Home 0 Modular 0 Special Use(Essential Public Facilities)** ❑ Commercial* 0 Boundary Line Adjustment 0 Change of Use ❑ Short Plat** ❑ Address 0 Road Approach 0 Binding Site Plan** , ❑ Home Business 0 Cottagelndustry 0 Long Plat** Propane ❑ Planned Rural Residential Development(PRRD)/Amendments** ❑Sign ❑ Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions** ❑Stormwater Management ❑ Shoreline Management Substantiall Development** ❑Site Plan Approval Advance Determination (SPAAD)* ❑ Shoreline Management Variance 0 Temporary Use 0 Comprehensive Plan/UDC/Land USe District Map Amendment ❑Wireless Telecommunication* 0 Jefferson County Shoreline Master)Program Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium 0 Tree Vegetaion Request 'May require a Pre—Application Conference **Requires a Pre-Application C nference Please identify any other local, state or federal permits required for this proposal, if known: DESIGNATION OF AGENT I hereby designate 61,1.(�S (4 I fJ E Pez p A4 1 e___`to act as my agent in matters relating to this application for permit(s). — Q �WNER SIGNATURE Abel Of Zth - ----- Dated) 0,W 2 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 irabiiities,judgments,court cons,r asotiabk,attorney's fees and r 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. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the applicati t t he or she wants ri otice �1 ignature: 21 � Date: ) ' e),Q61Jy, 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 I' "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 Rh the J on County development code.The Applicant acknowledges that he,she or it holds individual and non-transfers sponsibility for dhering complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: A/ `L` I Date: 1 % ..2op (is\YcrinitCcnter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc rtr...4. •h BUILDER STATEMENT • _I The sig2er of this statement does hereby•ertify 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: I GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: St4rASIH l0E PRopail . (360) 3s5- 5797 ( 360) 3Bs-5875 MAILING ADDRESS: '0 853 '4k)0 y n I U e_ I. t-i_ EMAIL: I 11'41)3(,(y1S figie. pro Pine a C ci CONTRACTOR'S LICENSE WAINS NUMBER: SU hSN P+ D77 Q P NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: New fl Wood Existing: 1 1 Sewer Addition [1 Steel Proposed: Bank i I Community System Alteration/Remodel II Concrete Total: Height: I I Individual System Repair 1] Masonry SEP Permit# Demolition I I Other: Bedrooms: Water Supply: Existing: Setback: I I Private well ❑ Two Party Type of Heat: Proposed: n 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 Proposes IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No If this is a Pro ane Tank and/or A liance Installation ermit,mark all items below that appl i Underground Tank Above ground Tank` Size of Propane Tank: c: ,S ✓ • i Heat Stove i Cook -cave rWoodstove i Fireplace Insert i Hot Water Tank I Pellet Stove I 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 Amoun Revision Main Floor Heated EH BId App Review: 2na Floor Heated Consistency Review: Other Heated Base fee: Mezzanine Additional Section: Heated Basement Plan Check fee: j EB 2 2039 Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: ' Garagc/Carp°" SUBTOTAL Decks 911/Rd Ap proach fee: Other . TOTAL: $ Receipt Number: - Cash/Check Number: ESTIMATED COST(REQUIRED) Date: 'Fair market value of all labor and materials foundation to finish Initials: (;:\PcnnitCentcr\tttttml+ORNISittttt\DRl)FORMS\MasterPermit Application 12-I9-2(t)6.doc • 1 • , • !, . • 1 --• • i . ! i. • 1 , 1 ; i 1 ! - ._... .. __ 1 , , , 1 ..-1, 1-dokil .s -re.) ; 0 , •:,, ( .1 _____ , __.. , 1 , , , . I— I , 1 .i 1 >o/. . (7 1 ,• (D61-11 i 1 Aic i d /4 Iv zg 4fr\ 33iel I , . I FEB 2 2009 , • ••••_ • i i , , •, , . , i . / 1 : : Lld I I ,, c-- ) 6 ri "7, ,. i3Z. /--( `-. i ri ) ) ',/. i.,Art. :2..d5 1;61, /,e._ . :. (• . , . . , :. - • .. ,!•. !..., ; . _ .. .. er ) / -• /6 O / C;)(-- !H • ; I ; ! ; • ; ! f' -- / -') .! ,i (,,,I 1 [ . ' I IV , .. • 1 ..__. 1 , , !I I . , 1 5 , 1 ; • , • , • ,_•_• 1_ __, , 1 I i Ylir C..) ...--- i!7 6 ' ! • , . , , 4-!--, • -,.! ,-• ..... . ... __ . ; i 1 ... , , , , . ! , :_• - --., Sc)' ! 1 1! 1 • ! ! ' ' ' ! ' ' I • 1 ' ! 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