HomeMy WebLinkAboutBLD2013-00174 0 0
MECHANICAL AND DEMOLITION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD13-00174 Received Date 6/10/2013
SITE ADDRESS: 191 S PALMER DR Issue Date 6/10/2013
PORT TOWNSEND, 98368
APPLICANT: BONNIE MAE BLOSSOM PHONE: 360-683-3901
LETA FRANCES FORD JTWROS
191 SO PALMER DR
PORT TOWNSEND WA 98368
SUBDIVISION: CAPE GEORGE COLONY DIV 4 Block: Lot:
PARCEL NUMBER: 938701103 Section: 12 Township: 30N Range: 02W
CONTRACTOR: AIR FLO HEATING COMPANY INC PHONE: 360-683-3901
221 W CEDAR
SEQUIM WA 98382
Contractor's License AIRFLI"206DG Expires 4/25/2014
OWNER, BONNIE MAE BLOSSOM PHONE: 360-683-3901
if different: LETA FRANCES FORD JTWROS
191 SO PALMER DR
PORT TOWNSEND WA 98368
PROJECT DESCRIPTION: 2 ductless heat pump systems
Directions
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 6/10/2014.
REQUIRED INSPECTIONS:
Tank/Line/Appliance:
FinalApproval: ` Co -t. i3
BUILDING INSPECTION HOT-LINE 379-4455.
REQUESTS MUST BE RECEIVED BY 3 PM THE DAY BEFORE THE INSPECTION IS NEEDED.
Office Hours 9:00 a.m. -4:30 p.m. Monday-Thursday
HOT LINE AVAILABLE 24 HOURS A DAY
\\tidemark\data\forms\F_BLD_Permit_Propane.rpt 6/10/2013
BIDING PERMIT APPLIC*IOO BLD13-00174
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD13-00174 Received Date: 6/10/2013
SITE ADDRESS: 191 S PALMER DR
PORT TOWNSEND, 98368
OWNER: BONNIE MAE BLOSSOM PHONE: 360-683-3901
LETA FRANCES FORD JTWROS
191 SO PALMER DR
PORT TOWNSEND WA 98368 CAPE GEORGE COLONY DIV 4
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 938701103 Section: 12 Township: 30 N Range: 02 W
CONTRACTOR: AIR FLO HEATING COMPANY INC PHONE: 360-683-3901
221 W CEDAR
SEQUIM WA 98382
Contractor's License AIRFLI*206DG Expires 4/25/2014
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION 2 ductless heat pump systems
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP MEC
VALUATION MAIN:
CODE EDITION: 2009 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 $228.00 MEB 06/10/13 142160
Total: $228.00 APPROVED
JUN 10 2013
Jefferson County DCD
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d4, JEFFERSON COUNTY
1 I DEPARTMENTOFCMUNDLOE621SheridanStreet• PortTownsend Washington 98368 iJUN 1 0 2013
Islarrigill:13
360/379-445O • 360/379-4451 Fax jefferson.wa.us/commdevebpment
/EFfERSON COUNTY U' li
Master Permit Application M� D- COMMUNITY SFVEI Q ) _____
Project Description(include separate sheets as necessary):
t461.. ki.. 'TWO D ki CIL-e 5g E4g 'i QUMAP SYS-rEM S
Tax Parcel Number. / ) S..'7 U /) J j Property Size: (acres/square feet)
Site Address and/or Directions to Property:
At 5• PAL-,&E R.' D kv a f D k_l '1Ov4 N 5s t4 b
Prope Ownerr(1s)of Record:�y _ Le Fr"a.AeG S F rJ
MailsTele 3 s i6, (!9 Fax: email:
Po LI ev3$5 -14 I �n1 A at3�I
Mailing Address: 141 5. iPALME R�iDRk�E
Appticant/A ent(if different from owner): to 11L F L-0 1-}Q"1 ,N & "
Telephone:�(0- (Qit3-34i O1 Fax:Nab- (On- 35'11 email: ;f"/9 Pc aacerh4uryLr .t)e.4
Mailing Address: _
What kind of Permit?(Check each box that applies
❑Budding 0 Critical Areas Stewardship Plan
O Demolition Permit 0 Variance(Minor,Major or Reasonable Economic Use)
Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a),C(d),or CI**
❑ Manufactured Home 0 Modular 0 Discretionary'D'or Unnamed Use Classification
❑ Commercial* ❑Special Use(Essential Public Facilities)"
O Change of Use 0 Boundary Line Adjustment
❑ Address 0 Road Approach ❑Short Plat"
❑Home Business 0 Cottage Industry 0 Binding Site Plan•'
O Propane 0 Long Plat"
❑Sign 0 Planned Rural Residential Development(PRRD)/Amendments••
❑Allowed"Yes'Use Consistency Analysis 0 Plat Vacation/Alteration"
U Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions••
❑Site Plan Approval Advance Determination(SPAAD)' 0 Shoreline Management Substantial Development"
o Temporary Use 0 Shoreline Management Variance
❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment
❑Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment
•May require a Pre—Application Conference 0 Tree Vegetation Request
"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 Ai,-1'iglial if v1611071 C o nto act as my agent in matters relating to this application for permit(s).
OC.G OWNER SIGNATURE LL li[A-•4dt, 4- /[rL/C Date: d&—d G" 2013 •
By signing this appiication form,the owner/agent attests that the information provided herein,and in any atitaidwner ,,is true and correct to the best of
his,her or its 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.
!further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorneys 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 rght 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 application that tr�or she wants prior notice.
it �
Signature: t - -l(/ts-n a t4 t-rxiP Date: Dfr —0 L.—.o/3
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 Ad'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 vitiate 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-transferable responsibility for adheri to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: 'is /+-aff•- -.F+-s. a^/Q Data: D G—D L —at,/3
G:\PeamtCenrer\###FORMS###1DRD FORMS\Idartet Peen/Application 52m&doc
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