HomeMy WebLinkAboutBLD2013-00032 BLD13-00032
BUILDING PERMIT APPLI TION Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD13-00032 Received Date: 1/28/2013
SITE ADDRESS: 90 E RHODODENDRON DR
PORT TOWNSEND, 98368
OWNER: MARILYN J MITCHELL PHONE: 360-385-3277
RODERIC J MITCHELL
90 E RHODODENDRON DR
PORT TOWNSEND WA 98368-9483 CAPE GEORGE COLONY DIV 3
SUBDIVISION: Block: 6 Lot: 10
PARCEL NUMBER: 938400609 Section: 12 Township: 30 N Range: 02 W
CONTRACTOR: EVERWARM INC PHONE: (360)452-3366
257151 HWY 101
PORT ANGELES WA 98362
Contractor's License EVERWI*088NL Expires 9/17/2014
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION WOOD FIREPLACE INSERT
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP MEC MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 2009 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 By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $152.00 LYK 01/28/13 139944 APPROVED
Total: $152.00
JAN 2 8 2013
Jefferson County DCD
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CERTIFICATE OF OCCUPANCY
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
Carl Smith, Director/Building Official
PERMIT#: BLD13-00032
SITE ADDRESS: 90 E RHODODENDRON DR Issue Date: 01/28/2013
PORT TOWNSEND, 98368 Final Date: 3/4/2013
APPLICANT: MARILYN J MITCHELL PHONE: 360-385-3277
RODERIC J MITCHELL
90 E RHODODENDRON DR
PORT TOWNSEND WA 98368-9483
SUBDIVISION: CAPE GEORGE COLONY DIV 3 Block: 6 Lot: 10
PARCEL NUMBER: 938400609 Section: 12 Township: 30 N Range: 02 W
PROJECT DESCRIPTION:WOOD FIREPLACE INSERT
THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2009
EDITION.
OCCUPANCY GROUP:
TYPE OF CONSTRUCTION:
SPRINKLER SYSTEM yes no
THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 3/4/2013
\\tidemark\data\forms\F_BLD_Occupancy.rpt 3/20/2013
�.1•501v Oo JEFFERRN COUNTY
w� ' 6.., DEPARTMENT OF COMMUNITY DEVELOPMENT
r' ` ` 621 Sheridan Street• Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
p� www.co.jefferson.wa.us/commdevelopment
Is,
aster Permit Application MLA: nO +�
Project Description(include separate sheets as necessary):
Tax Parcel Number: Property Size: (acres/square feet)
Site Address and/or Directions to Property:
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Property Owner(s)of Record: Fbp /42_&- LL,
Telephone: ra`"'3015'--3Z+11 Fax: email:KbPoice=•cAisexasam
Mailing Address: SAME,
E,
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies ❑Lot or Road Segregation
lit wilding ❑Critical Areas Stewardship Plan
Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use)
❑Single Family ❑Garage Attached/Detached ❑Conditional Use[C(a),C(d),or C]**
❑ Manufactured Home .❑ Modular ❑Discretionary"D"or Unnamed Use Classification
❑ Commercial* ❑Special Use(Essential Public Facilities)**
❑ Change of Use ❑Boundary Line Adjustment
❑ Address ❑Road Approach El Short Plat**
❑Home Business ❑Cottage Industry ❑Binding Site Plan**
❑Propane ❑Long Plat**
❑Sign -_- ❑Planned Rurai Residential Development(PRRD)/Amendments**
El Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration**
❑Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions**
❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development**
❑Temporary Use ❑Shoreline Management Variance
❑Wireless Telecommunication* ❑Comprehensive Plan/UDC/Land Use District Map Amendment
❑Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment
*May require a Pre—Application Conference ❑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_,- to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE Date:
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 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.
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 sole purpose of application
review and any required later ins•-- ions.. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the application,/`IT: or -,•, r•tice/ /�
i 'Signature: L.ti /-c Date: �a
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
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 yo e in • pli-na 'h •- Jefferson County development code.The Applicant acknowledges th he,sh r it holds individual
and non-transf re on 'i i��:Act•- f nd complying with the ESA. The Applicant has read this discla' er and nd dates it below.
i nature: /� /4 Date: l 2
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