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HomeMy WebLinkAboutBLD2004-00774 JILDING PERMIT APPLICA4N 13 RDOe 007w pe74 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD04-00774 Received Date: 12/8/2004 SITE ADDRESS: 140 KALA HEIGHTS DR PORT TOWNSEND, 98368 OWNER: ROBERT F LOWE PHONE: (360) 379-6670 ADELE A LOWE 41 BUCKHORN PL PORT TOWNSEND WA 98368-9548 SUBDIVISION: KALA HEIGHTS-PUD PHASE A Block: Lot: 2 PARCEL NUMBER: 965800002 Section: Township: Range: CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTPI983O6 Expires 09/26/2006 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOF U/G 500 GAL PROPANE TANK, COOK STOVE, FIREPLACE INSERT, GAS PIPING TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2003 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: 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 Routing Date: F&W Landslide Shoreline Aquifer Forest: Commercial Rural Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $48.00 KAS 12/08/04 68791 Total: $48.00 - .- ) .0 14f, RO4�R ti • • '! - - r____ 4 L ROOF,YARD DRAINAGE TIGHTLINE TO COMMUNITY STORM SYSTEM14) I ,_, , I , O l i 484RSEpr,q ek I 11; �i y.il Ic) 0 ercoinve _f 0; . - 1 Av,,Da,&e.. 1 c;1-. :;; kw frrAd_ • N a = a J o = • ' Hee4 W vi III • IH iliNN l A4/0 InRAi<tAI40it ' O 1:: II tl jAz, Prak„, 1 ;"0 0 G d 110i4, -rue mii R � ,N, Jrit•4 7. 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T` !�,� PROPERTY LINE -N, � 1 41,1 iii.71 _ ._. %lI �nl/lll�/�llli ip m' 86.36' OA I� /Ob.36' ),4‘ - $C31 0 t__________ KALA HEIGHTS DRIVE 1 - - - - J LEGAL:LOT 2 KALA HEIGHTS • • 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 #: BLD04-00774 Received Date 12/8/2004 SITE ADDRESS: 140 KALA HEIGHTS DR Issue Date 12/8/2004 PORT TOWNSEND, 98368 APPLICANT: ROBERT F LOWE PHONE: (360) 379-6670 ADELE A LOWE 41 BUCKHORN PL PORT TOWNSEND WA 98368-9548 2 SUBDIVISION: KALA HEIGHTS-PUD PHASE A Block: Lot: PARCEL NUMBER: 965800002 CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTPI983O6 Expires 09/26/2006 OWNER, ROBERT F LOWE PHONE: (360) 379-6670 if different: ADELE A LOWE 41 BUCKHORN PL PORT TOWNSEND WA 98368-9548 PROJECT DESCRIPTION: U/G 500 GAL PROPANE TANK, COOK STOVE, FIREPLACE INSERT, GAS PIPING 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 12/08/2005. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: /— 16 ©S 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 10/29/19c, '. /SON 0 ,�' O JEFFER COUNTYIII , DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan.Street• .Port Townsend_ Washington 98368 360/379-4450 • 360/379-4451 F BINp ax p www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: Project Description (include sepa eets as necessary):7r o palm-- /a/7i Tax Parcel Property Number: C? '5-- 4Q — QQ vZ' Size: �O,i CO d (acr quare fee Site Address and/or Directions to Property: r-, Or/�/. CP2&/7 d Property O ner(s)of Record: 0 i' -ei Tel 0�37 9 -- email:��, Mailing Address: / Z) /Y4�e'�-� i 1 '2 ,��``�`I /-)i' . f�DL I— / UU/Y)% i,1 C , Applicant/ ent(if different from owner): A"`" /e /�� Sh i e /,'.5 =n Telephon S- /� Fax: `3(?S-3/1 S email: d 6A l ekisc.Qi /yj 11s -Mailing Ad-rd ess: r• i?ei-- What kind of Permit?(Check each box that applies) ❑ Building ❑Variance(Minor,Major or Reasonable Economic Use) ❑ Demolition Permit 0 Conditional Use[C(a), C(d),or C]** ❑ Single Family 0 Discretionary"D"or Unnamed Use Classification ❑ Garage Attached/Detached ❑ Special Use(Essential Public Facilities)** ❑ Manufactured Home ❑ Boundary Line Adjustment ❑ Modular 0 Short Plat" ❑Commercial* ❑ Binding Site Plan" ❑ Change of Use 0 Long Plat** 0 Address ❑ Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments*" Propane ❑ Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions** ❑Stormwater Management ❑ Shoreline Management Substantial Development" ❑ Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Variance ❑Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment 0 Wireless Telecommunication* 0 Jefferson County Shoreline Master Program Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium *May require a Pre-Application Conference **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 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 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 ac ss and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any req ed later inspections. d right of entry to this property shall be requested and shall occur only du' g regular business hours �-? 7 / Signs • ����.� 5 'f/ et1 f . f Date: �0/ 9 `/7 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)eve if you a in compliance wi e Jefferson County development code.The Applicant acknowledges that he,s e or it holds individual and non- sferabie pol ility t ering to/and co lying with a ESA. The Applicant has read this d' ai —err an si and dates it below. Signatur . /�//f � n/ jt/ Date: G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc • III- OWNER BUILDER STATEMENT The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that theywilt.be.assumingthe responsibilityof the General Oontractoriorthe proposed;proj ect •}- ._ Signature: Date: GENERAL CT OR MAN RED HOME INSTALLER: PHONE: FAX: MAILIN ADDRESS: ^ /17�4rUm /� EMAIL: CONTRACTOR'S LICENSEit c f- Q cue ck, j ,� 9 p.3 37 WAINS NUMBER: lDUN7.. 983.0 cu�// O NUMBER ARCHITECT/ENGINEER: % PHONE MAILING ADDRESS: ( FAX'( ) EMAIL '' same Type: .. _eathrooms: .4, z shosr+eline: 0 New ❑ Wow Existing: Type of Sewage Disposal: CI ❑ Steel Proposed: Bank 0 Sewer ❑ Aferation/Remodel ❑ Concrete ❑ Community System Total: Height: ❑ Individual System SEP ❑ Repair 0 Masonry ❑ Demolition 0 Other Bedrooms: Water Permit# Existing: Setback: Water Supply: Type of Heat: Proposed: ❑ Private well 0 Two Party Total: 0 Public Name of System: If this is a Commercial Protect you must answer the following: Number of Parking Spaces: Current: Proposed: Number of occupants(includes owners,tenants,employees,etc) Current Number ofP DADA Parking Spaces: IBC Occupancy: � IBC Type of construction: Will you have Food Service? Yes / No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: Uride round Tank Size of rg ve ground TankPropane Tank: cS('� �lf�, 0 Heat Stove Coo Stove ❑ Woodstove 'Fireplace Insert 0 Hot W r Tank 0 Pellet` tone ❑ Other Is this applian Ina Installed in;a Manufa r 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. S•uare Foote: ..d� �©�a�l'a'9 -eve r� ;.�st�+�x. . t+n .y>. Current Proposed 4 7� ,:, fin,x ,,:.1-s y a x* cx- i 4r 1'� `` r� fPii ` Main Floor r p � � + sF `"`'" ;� y1L'�°r Q t a- , .: 4• va` tib�• r > iti, kit 2'"'Floor w; Y 4:. 3. `t a-- _�¢•-•, ; y i t a, • k � $y 3 `,#y. t �y tFTtS"^' < T l m c :10 St S . o "'" -'`. �$ W T.. 3"0 Floor �s t �, 1, 4 c' it, t 3 Y� . , �' • { t"`, xe.L-. S ..fir ' Mezzanine: - s „. r ,v. • .. -' w x 4 { L.,y 'S � 1 � Heated Basement �" ^�i , ,�* s' t - .. .,..�.: .. 3 ;iy i'--P52: 'vim -P. -4:4 ^, J .'._ � uti � `4 y . e ...' 5''4'r k )'A ' 'i, } y, .:r,Ya.^i, d ys�''r ^'<. 'r " 'c' kt Unheated Basement t ti €irate? ¢vxS�_k . `. `' 'k "1 6. „$,"� r�.,i e,6°rif.7Pasr 4` ri !p i "�•� ty`., ,: Yrr 41.�x �Ti�" J Other Unheated p . Garage/Carporf 0� • s� .,°�'�,0` 'i. _ .- ' SS r( '7 Y��. k a�t h t y '� .1 �.` yl'�i� Al.' C I.};x �,y �� pn Decks D.- 8 [ 7 u N1'v .<sl 3}ky . a *s Ys a rx Other s i2E� k t sa+ 4 x'i s s �--zz t` 'Y FA ArAt 44•' ,° '- s di ,.., !tip i-e q .l c to j c4.e 3:. s '•Z ESTIMATED COST(REQUIRED) ° �y ^ ' '"� �� � .4 •Fair market value of all labor and materials foundation to finish s ;= '�`" . " :,,�'V^' , 2 •; y-a 44, 's.,�i 1 f't' �.A' iV va "'-'� ; [ .. .s -caw it-:...��f a�.wv....rsL ^��+�i:: 'Y;s .�.v�ra4 �,�' �� ?�r��`_ ,�" Fs'k G:\PemvtCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc