HomeMy WebLinkAboutBLD2010-00172 •UILDING PERMIT APPLICJON BLD10-00172
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD10-00172 Received Date: 5/25/2010
SITE ADDRESS: 33 W ROSE ST
QUILCENE, 98376
OWNER: TERRIE BURNSTON PHONE: 360-765-3889
PO BOX 134
QUILCENE WA 98376
WORTHINGTON'S
SUBDIVISION: Block: 1 Lot: 1-5
PARCEL NUMBER: 999800101 Section: 24 Township: 27 N Range: 02 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI` TEMP FIREWORKS STAND - 4TH OF JULY FIREWORKS SALES - NO
MLA REQ'D
TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL:
TYPE OF IMP TMP MAIN: INDUSTRIAL:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 2006 HEAT BASE: HEAT TYPE:
OCCUPANCY:
OCCUPANCY: UNHEATED: #OF STORIES:
CONST TYPE: OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK. BANK HEIGHT:
SEWAGE DISPOSAL: NUMBER OF EMPLOYEES:
WATER SYSTEM:
BATHROOMS:
Exist:
Prop:
Total:
Routing Date:
I(2
Type Amount Paid By: Date: Receipt: APPROVED
Permit $71.00 LYK 05/25/10 117754
State Building Code $4.50 LYK 05/25/10 117754 JUN
Total: $75.50
Jefferson County Planning
&Building Departmen
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Jefferson County Buildinglvision Permit Niter: BLD10-00172
Applicant:
BUILDING PERMIT INSPECTION APPROVALS applicable Code: 2B006NSTON Interrnational Building Codes
To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection.
Requests received after 7:00 AM will not be scheduled for that day's inspections.
ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries.
The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection
Inspection Item Date Approval Signature Notes
Miscellaneous 6/21/2010 Setbacks
kitie
Miscellaneous 6/21/2010 Stucture
Miscellaneous 6/21/2010 Fire Inspection
Miscellaneous 1/3//0 'Tear-down/Clean-up
FINAL INSPECTION -7) 131►o
94--
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
_�- • •
JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT
621 SHERIDAN ST,PORT TOWNSEND WA 98368 PH: 360-379-4450
FIREWORKS STAND
PERMIT APPLICATION
SITE ADDRESS:A / ? l 1. /�O S e St
FILE
•
911#/ROAD NAME J l�/ �J�) / / L q c
�uiwlCe�e_ 1 "0 5A no I oln ZIP 1 Q 3 -2
n.9 DIGIT PARCEL ID NUMBER 99, er Op /O
APPLICANT tI e,rrl t.. 13u rri D►l PHONE 360 76 5 .3s--c /
MAILINGADDRESS P. Q. Ll ox /3 /
(cen e? (,t'a�1 ►‘,1 DY1 ZIP 98 37�
PROPERTY OWNER C e terhA. y E PHONE 36 0-62 / 7% 57 b 3
MAILING ADDRESS 75 N. to. h on-tio Son •
Po ul 4 0/ ) �a.51�t �t r1 ZIP 9e 3 70
7
STATE PERMIT# I C� o 1Sn J EXP. DATE / 3I` 074 I
By signing the application form,the applicant/owner attests that the information provided herein is true and correct to the best of their knowledge. Any
material falsehood or any omission of a material fact made by the applicant/owner 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 purpose of application
review and any required later inspections. Access and right of entry to the applicant's property or structure shall be requested and shall occur during
regular business hours. L/
APPLICANT SIGNATURE • DATE -5 / 7 I /0
FOR OFFICE USE ONLY BASE FEE 71.00 RECEIPT# -7 f 1>I
STATE SURCHARGE 4.50 CASH/CK# ,-16i4'5
TOTAL 75.50 DATE r-j I L?
k:\forms\forms\fireworks app.doc
You must submit a Site Plan and Floor Plan of the Stand
See attached checklists
1 _6 6.STAND DIAGRAM. cJlv/rJ ,o-0
ACCOUNT NAME: A.y ell4� . ifl, / _ ORDINANCE OF: ,0 Ce 1' —
141RMAN: �c-rr+P- Ru_r-rtS�o 71 BOND AMOUNT: EXPIRES ON:
TELEPHONE: HOME 7 7! 5 , WORK sue- SETBACK REQUIRED: CURB/WALK: GAS:
STAND ADDRESS: 71q e✓d"s 5i //_ ./ OTHER: BLDG:
STORE/SHO
PPING CENTER: � '� i/W P,ICA-I al r C7J STAND FACES DIRECTION OF: `
CITY AND STATE: Gc I C--11 P . NOTES:
CROSS STREETS: OS 9_, AND /e /
STAND SIZE: TYPE STAND CREW INFORMATION
ADDTL MTR'L: UPCREW: _
STAND NOTES: • DATE UP: DATE DOWN: —
DOWN CREW: —
GARBAGE REMOVAL: YES NO ._..
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SHOW ALL SETBACKS FROM STRUCTURES. GAS. ETC.. ALONG WITH MAJOR BUILDINGS
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