HomeMy WebLinkAboutBLD2001-00299 •
BUILDING PERMIT
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451 (800) 831-2678
PERMIT #: BLD01-00299 Received Date 05/25/2001
SITE ADDRESS: 80 MOCKINGBIRD LN Issue Date 05/25/2001
PORT LUDLOW, 98365 Expiration Date 05/25/2002
APPLICANT: EUGENE GUIBERSON PHONE: (360)437-0347
GERD GUIBERSON
80 MOCKINGBIRD LN
PORT LUDLOW WA 98365
SUBDIVISION: PORT LUDLOW NO. 4 Block: Lot: 65
PARCEL NUMBER: 990500065 Section: 8 Township: 28 N Range: 01 E
CONTRACTOR: NORTHWEST CHIMNEY SERVICE PHONE: (360)385-6998
Contractor's License: NORTHCS101CB Expires: 01/24/2002
Fe rre I Ij�IS
LOAN LENDER/
BOND HOLDER:
PROJECT DESCRIPTION NO MLA REQ'D - PROPANE TANK& STOVE INSTALLATION
REQUIRED INSPECTIONS:
[ ] Setbacks (Shoreline Setbacks):
[ ] Footings:
[ ] Foundation:
[ ] Underground Plumbing/Underground Insulation:
[ ] Shear Wall:
[ ] Framing/Plumbing: J .
[kV Propane Tank/Lines: p k 1/2-4(0( d ��7bw►-O'��-
[ ] Insulation:
[ ] Sheetrock:
[ Final/Occupancy Approval: /rrJ ` ,gy (tot.--- i�� C /
HEALTH DEPARTMENT APPROVAL REQUIRED PRIOR TO FINAL INSPECTION.
THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED
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_Buildng.rpt 10/29/19
BUILDING PERMIT APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD01-00299 Received Date: 5/25/2001
SITE ADDRESS: 80 MOCKINGBIRD LN
PORT LUDLOW, 98365
APPLICANT: EUGENE GUIBERSON PHONE: (360)437-0347
GERD GUIBERSON
80 MOCKINGBIRD LN
PORT LUDLOW WA 98365
SUBDIVISION: PORT LUDLOW NO. 4 Block: Lot: 65
PARCEL NUMBER: 990500065 Section: 8 Township: 28 N Range: 01 E
CONTRACTOR: NORTHWEST CHIMNEY SERVICE I OVIL PHONE: (360)385-6998
510 DEKALB
SUITE D
PORT ORCHARD WA 98366
Contractor's License NORTHCS101CB Expires 01/24/2002
ARCHITECT/ he-✓re i I AQ
ENGINEER : '
PROJECT DESCRIPTION: NO MLA REQ'D - PROPANE TANK & STOVE INSTALLATION
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW
VALUATION MAIN:
CODE EDITION: 1997 ADD'L: HEAT TYPE:
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: # OF STORIES:
CONST TYPE: OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM: PARCEL TAGS: YES NO
BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA
Exist: Exist: Wetland Erosion
Prop: Prop: Seismic Streams
Total: Total: Flood Way Floodplain
F&W Landslide
Routing Date: Shoreline Aquifer
Forest: Commercial Rural
—Proximity - F'Iat Conditions
Type Amount Paid By: Date: eceipt: Approved/Date
Propane Tanks/Stoves $48.00 MAM 05/25/01 40136
Total: $48.00
,IEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 PH: (360) 379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE PROPANE TANK PELLET STOVE OTHER S-4 .,�
SITE ADDRESS:
911#/ROAD NAME
�Q ZIP
p
9 DIGIT PARCEL ID NUMBER J —1 O bOb4 S'
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT PHONE
MAILING ADDRESS
ZIP
PROPERTY OWNER e aceet C:GG/10 ,e,JO HONE 4(37 l/ 03 4
MAILING ADDRESS /� ///Ll ,t�/ie L 1 �/¢�e-
o!z t- A�dJ 1 4 ZIPYer%—g6s
CONTRACTOR N.W GHif'ii �'S P JiC'E F-EuE _G A PHONE
5j0 be KuL-5 PO Bo I`357
MAILING ADDRESS pp� pre(MxIRl))WA Po Tr;vINScND WA R83(ofi
C3(oo) g-710- 3(e0) 3EC-- &`I415 ZIP
STATE LICENSE# 100 I-411-'47 I L00/ _SS,3 - 54 2 EXP. DATE -7/31/0
FEDERAL I.D. # r eELs5 L
een/ C1� N��2►HSC�R4 B i t Qac i/z4 �oz-
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 it's 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.
APPLICANT SIGNATURE DATE / /
FOR OFFICE USE ONLY
BASE FEEx
? r Yid Ajy
TOTAL A L ,.
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