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Home My WebLink AboutBLD2005-00738 fik UILDING PERMIT APPLICASJN BLD05-00738 Jefferson County Department of Community Development Review Type: 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD05-00738 Received Date: 11/28/2005 SITE ADDRESS: 2570 EAST QUILCENE RD QUILCENE, 98376 OWNER: MARJORIE D BELT BRIAN S BELT PHONE: 2570 E QUILCENE RD QUILCENE WA 983768529 SUBDIVISION: Block: Lot: T 26 PARCEL NUMBER: 701301016 Section: 30 Township: 27 N Range: 01 W CONTRACTOR: ECONOMY HEATING AND SHEET METL 8753 SR 303NE PHONE: (360)385-6883 BREMERTON WA 98311 Contractor's License MOUNTPI983O6 Expires 9/26/2006 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP INSTALL 120 GAL A/G PROPANE TANK, PIPING AND FURNACE TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION MAIN: CODE EDITION: 2003 ADD'L: HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: # OF STORIES: CONST TYPE: OTHER: CONST TYPE: GARAGE: SHORELINE: DECK: SETBACK: SEWAGE DISPOSAL: BANK HEIGHT: WATER SYSTEM: - BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: 1, Type Amount Paid By: Date: Receipt: pppayyttPropane Tanks/Stoves $49.00 PRB 11/28/05 77438 E�p Total: $49.00 4 NOVgam Jefferson County Planning & Buildi epartment Foe .. 1110 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 #: BLD05-00738 Received Date 11/28/2005 SITE ADDRESS: 2570 EAST QUILCENE RD QUILCENE, 98376 Issue Date 11/28/2005 APPLICANT: MARJORIE D BELT BRIAN S BELT PHONE: 2570 E QUILCENE RD QUILCENE WA 983768529 SUBDIVISION: T 26 Block: Lot: PARCEL NUMBER: 701301016 Section: 30 Township: 27N Range: 01W CONTRACTOR: MOUNTAIN PROPANE 265 CHIMACUM RD PHONE: (360)385-6883 PORT HADLOCK WA 98339 Contractor's License MOUNTPI983O6 Expires 9/26/2006 OWNER, MARJORIE D BELT if different: BRIAN S BELT PHONE: 2570 E QUILCENE RD QUILCENE WA 983768529 PROJECT DESCRIPTION: INSTALL 120 GAL A/G PROP• E TAN / IPING A FURNACE THIS PERMIT IS VALID FOR ON - • I. NOT - N • . THE FINAL INSPECTION MUST BE SCHEDULED AND P• • WITHIN THAT YEAR THE EXPIRATION DATE IS 11/28/2006. REQUIRED INSPECTIONS: Tank/Line/Appliance:____jdNK 4 Fit Qp c.E Oti.„ I/1,764, 1,/ 1 FinalApproval: OK 44 Cl na-1 (a 14 a 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 10/29/19 4olv coo. JEFFE N COUNTY • ,, �� A7 14 ` DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend • Washington 98368 NOV 2 8 200 360/379-4450 • 360/379-4451 Fax 44S, NG ) www.co.jefferson.wa.us/commdevelopment Ii Master Permit Application MLA: Project Description(include separate sheets as necessary): 9�4-1 1 >i ti I l pro pa el P rot n/{ / 19(ua-t inq i.F (—.,4 r vtu r Tax Parcel Property P FPe7 •Number: 7 / 7e / (,' /� Size: / _gy OW) r�Pe (acres/square feet) Site Address and/or Directions to Property: zs 70 E05T c✓N r/c,o,,e Gio i/r,w/1 / I.dU,.i 8' z 76 Property Owner(s)of Record: .41 ca t jc r i e •4-- „r-in v. 3oo IT Telephone: 060 76S 3`i`/0 Fax: email: Mailing Address: ;2 3 70 . 0,4 i 1 C.Ptir t is. CL4i l et=n-P, L _C , 9?-37d Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies) ❑ Building ❑ Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit ❑ Conditional Use[C(a),C(d),or C]** ❑ Single Family ❑ Discretionary"D"or Unnamed Use Classification ❑ Garage Attached/Detached ❑ Special Use(Essential Public Facilities)** ❑ Manufactured Home ❑ Boundary Line Adjustment ❑ Modular ❑ Short Plat** ❑ Commercial* ❑ Binding Site Plan** ❑ Change of Use ❑ Long Plat** ❑Address LI Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** W.-Propane ❑ Plat Vacation/Alteration** I]Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions**[1 Stormwater Management ❑ Shoreline Management Substantial Development** ❑ Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Variance ❑Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* ❑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 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 inspections.Access and right of entry to this property shall be requested and shall occur only during regular business hours. ,� // Signature: r r..�c..P 1 �'`t Date: 2 j /c 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 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 adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: `f9-� G/]_E LG-- Date: ,. - ;'S - __ G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc • OWNER BUILDER STATEMENT III The signer of this statement does hereby certify that they are the Owners of the parcel referenced erenced herein,that they are not licensed contractors and that they will be assuming the responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL FAX: MCONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: ( ) , OU v11 dt e (30 Pa 11-<-- —26- C Ai i-,c,J.u wt Al o r7 Had Ito<41„&6e) )._. 5 6 SG MAILING ADDRESS: L(, 4l 4)- /- /( / ,, M EMAIL: t c " -/ NP,. , ^'J . 5,1“7:re-4,4 ! WAINS CONTRACTOR'S LICENSE NUMBER NUMBER: �'. I r(A( k, 'J•7 3 STt.T e if">ti .3-0 5 tv= ARCIitTEL'7�• r�i-v,r. 47r-"la.� 14..),ti , i�j S 1 / PHONE ( ) FAX:( ) MAILING ADDRESS: V EMAIL ilt Mou c,Project Type: ir ns: Shoreline: Type of Sewage Disposal: ❑ Sewer ❑ New / j: Bank ❑ Community System ❑ Addition FJ/�//Ci({�y Total: Height: ❑ Individual System ❑ Alteration/Remodel 145,1 1/n r-r,� SEP Permit# II Repair S iLG�9/r s i ms: Water Supply: ❑ Demolition (Oil*''Ci C f7�'s Li Lar,$e I• Setback: ❑ Private well I i Two Party Cf�OY255 f/ ad: I I Public Type of Heat: Total:I /�O Name of System: If this is a Commercial Project you must answer the following: Number of ADA Parking Spaces: Number of Parking Spaces: Current: Proposed: Number of occupants(includes owners,tenants,employees,etc) Current Proposed 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: (i Underground Tank tie-Above ground Tank Size of Propane Tank: 'L, ❑ Heat Stove [] Cook Stove ❑ Woodstove LI Fireplace Insert 1 I Hot Water Tank ❑ Pellet Stove [Other FI) r in o t k---- Is this appliance being installed in a Manufactured I Mobile Home? Yes / ; When applying for a permit to install a propane tank you must also submi 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. I Square Footage For Office Use Only Amount r. 4 t Current Proposed Main Floor Consistency Review: 2Nu Floor j" ix(Base fee: y,(0 ,l,,/,�t, J lit• on 3`°Floor Additional Section: I Mezzanine: Plan Check fee: Heated Basement State Surcharge fee: Unheated Basement Pot Water Review fee: Other Unheated 911/Rd Approach fee: Garage/Carport TOTAL: $ 1-7L. 50 Decks Receipt Number: 77 177 '; ^ Other Cash/Check Number: C 4 ESTIMATED COST(REQUIRED) Date: tt(i- 6/C) .Fair market value of all labor and materials foundation to finish Initials: I G:\PemutCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc 7 O _, 0 ‘ 3 m _ ______ . ____________7_,_.„.„,,,o,0 ...„) ,...... .. 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