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Home My WebLink AboutBLD2005-00779 • 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 #: BLD05-00779 Received Date 12/19/2005 SITE ADDRESS: 131 MAGEE RD Issue Date 12/19/2006 QUILCENE, 98376 APPLICANT: DANIEL A WAGGONER PHONE: (360) 765-3588 131 MAGEE RD QUILCENE WA 98376-9525 SUBDIVISION: Block: Lot: PARCEL NUMBER: 802233004 Section: 23 Township: 28N Range: 02W CONTRACTOR: EVERWARM INC PHONE: (360)452-3366 257151 HWY 101 PORT ANGELES WA 98362 Contractor's License EVERWI"088NL Expires 8/17/2008 OWNER, DANIEL A WAGGONER PHONE: (360) 765-3588 if different: 131 MAGEE RD QUILCENE WA 98376-9525 PROJECT DESCRIPTION: WOODSTOVE FIREPLACE INSERT 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 12/19/2007. REQUIRED INSPECTIONS: Tank/Line/Appliance: r/lZ # - /AST /N 1 LLAh /A) b`jt/iTiaib FhP. L.OGt FinalApproval: 7� -�ot -1�/n,„-J 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 BUILDING PERMIT APPLICA1N B RD05-00779 Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD05-00779 Received Date: 12/19/2005 SITE ADDRESS: 131 MAGEE RD QUILCENE, 98376 OWNER: DANIEL A WAGGONER PHONE: (360) 765-3588 131 MAGEE RD QUILCENE WA 98376-9525 SUBDIVISION: Block: Lot: + PARCEL NUMBER: 802233004 Section: 23 Township: 28 N Range: 02 W CONTRACTOR: EVERWARM INC PHONE: (360) 452-3366 257151 HWY 101 PORT ANGELES WA 98362 Contractor's License EVERWI*088NL Expires 08/17/2006 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION WOODSTOVE FIREPLACE INSERT 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: 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 $49.00 KAS 12/19/05 78772 Total: $49.00 , 4iON cO JEFFERS COUNTY i1---•-) 1F'F — - ti # DEPARTMENT OF COMMUNITY DEVELOPMENTS i '� ` `-4 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax ww.co.jefferson.wa.us/commdeve ment S NOBS ) P 0 EC 1 9 2005 Master Permit Application MLA: Project Description(include separate sheets as nece ary): j � � V t t'e.r p[cl _c. —1 �n s . (' i n S 4. IqT11 t.� lJ>`Jd f1.cL^� Tax Parcel Property - Number: .0.2—2.-3- 0 0 9 Size: (acres/square feet) Site Address and/or Directions to Property: _t -61 J\AG C_t / Cl CC ` ,r\Q __ Property Owner(s)of Record: �0.,r�i Q i (L9�.a1 c3,n` " .— --� Telephone: `7 `3$•' Fax: �J email: _.� 3 Mailing Address: 13[ (V1a. e.0 ? Ca c I. co - v..)Applicant/Agent(if different from o�lriner): �c,C 0.104_e ev v Telephone: ' 750 '(e. Fax: email: Mailing Address: r 10 [ ` -A F _ 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 ❑Road Approach ❑ Planned Rural Residential Development(PRRD)✓Amendments-- ❑ Propane 0 Plat Vacation/Alteration** ❑Mowed"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 ❑ 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 r;..• I hereby designate (—Le& to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE ". 14:r Date: I (/ jlp�' By signing this application form,the owner/ 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 se 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 attomey'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 a..-ss and right of entry t Jefferson County and its employees,representatives or agents for the sole purpose of application review and any required : - ins and right of entry to this property shall be requested and shall occur only during regular business hours. < Signature: Date: C i1 The action or actions Applicant will and k s a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a ntial"take"of an endangered species as those terms are defined in the federal law known as the "Endangered Species Act"or"ESA."Jeffe 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' compliance with the fferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferable r nsibili adh ' g to and complying wi the ESA. The Applicant has read this disclaimer nd sig s and dates it below. Signature: Date: ) I�30/G S G:APcnnitCenter\FORMS\DRD FORMS\i, .t• ennit Application 7-8-04.doc • • 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 they will be assuming the responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: Ev a-CtA_Ic>, c r,-� ecti{'1-In 4- fit-ramp cf (P550 750 '7 5-( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX: ( ) MAILING ADDRESS: 2....�j`7 j 1 1...1w> I 1 ? �/ EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: 0 Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ Repair 0 Masonry SEP Permit# ❑ Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: ❑ Public Total: Name of System: If this is a Commercial Project you must answer the following: Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces: 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: ❑ Underground Tank ❑ Above ground Tank • , . i4e of Propane Tank: ❑ Heat Stove ❑ Cook Stove CI Woodstove Fireplace Insert ❑ Hot Water Tank ❑ Pellet Stove ❑ Other Is this appliance being installed in a Manufactured/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. Square Footage For Office Use Only Current Proposed Amount Main Floor Consistency Review: , i 2N1"Floor ') C Base fee: • 3fa Floor .Additional Section: NI Mezzanine: Plan Check fee: J Heated Basement State Surcharge fee: - Unheated Basement Pot Water Review fee: Other Unheated 911/Rd Approach fee: Garage/Carport TOTAL: $ Decks Receipt Number: 1 r) 1►--I f) C� l Other --- Cash/Check Number: L� J4 ESTIMATED COST(REQUIRED) Date:.Fair market value of all labor and materials foundation to finish ' , 1065 (� )I (lnr Initials: C/A) G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc O 2 n C, D C D P r C/) r. . m V m m Cn e 0%) � lr C r r m 0o r O n '• D cn 4 m Q -o x 0 m z c 0 .13 C P o -; 4 -D co • 1a' /" Z