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Home My WebLink AboutBLD2006-00131 • ! 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 #: BLD06-00131 Received Date 3/23/2006 SITE ADDRESS: 13474 AIRPORT CUTOFF RD Issue Date 3/23/2006 PORT TOWNSEND, 98368 APPLICANT: CALVARY COMMUNITY CHURCH - PT PHONE: 360-385-6469 13474 AIRPORT CUTOFF RD PORT TOWNSEND WA 983689320 TAX2, SUBDIVISION: Block: Lot: PARCEL NUMBER: 001283026 Section: 28 Township: 30N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2006 OWNER, CALVARY COMMUNITY CHURCH - PT PHONE: 360-385-6469 if different: 13474 AIRPORT CUTOFF RD PORT TOWNSEND WA 983689320 PROJECT DESCRIPTION: GAS FIREPLACE INSTALLATION TO OLD PROPANE TANK 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 3/23/2007. REQUIRED INSPECTIONS: Tank/Line/Appliance: inalA• royal: (o/q/ too‘, 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 - 3 06 03: 07p Levi 1 -360-385-5875 p. 2 410 Ilk SITE VISIT REPORT (PLOT PLAN) DATE : CONTACT: PHONE #: FAX #: Email PLANNER: 1.A3r6ArG\ E4tsTik,5 101001.5 tte.a-y-s preltoat,(1 611 S+4-I-Jb-e 1\144.,-1fire /a L-o V\--/ oN cod JEFFERSON CWSJTY • ' '� DEPARTMENT OF COMMUNITY DEVELOPMENT ` 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379/-4451 Fax It, www.co.jefferson.wa.us/commdevelopment aster Permit Application MLA: )ject Description(include separate sheets as necessary): frfi , •—c i- e- - Tax Parcel Property Number: 0 0( oa e 3 0 .,(a Size: (acres/square feet) Re Address and/or Directions to Property: I. 4(7 4 A/1 ✓1 o r-t e...14.1 1 74) 'roperty Owner(s)of Record: <262--e c'a-1--t. nr r-,-,```h-t C<.,-.•.,-- telephone: 3dL5 - is G f` U Fax: email: Mailing Address: ,S-- Applicant/Agent(if different from owner): jitij Telephone: Jd'J —S797 Fax: email: Mailing Address: /A sT? , 01.t 4 t. li I 2(4.•,A-6.0, G)ry• /.f3 3 What kind of Permit?(Check each box that applies) • t I Building 0 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 El Boundary Line Adjustment ❑ Modular ❑ Short Plat** ❑ Commercial* ❑ Binding Site Plan** ❑ Change of Use 0 Long Plat** ❑Address L1 Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** Propane ❑ Plat Vacation/Alteration** 0 Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions** Li 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 ❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment Li Forest Practices Act/Release of Six-Year Moratorium *Ma •.uire a Pre-A•.lication Conference **Requires a Pre-Application Conference Please identify any other local, state or federal permits required for this proposal, if known: /•- .'''' SIGNATIO► e • GENT I he -ey t -ct as • .gent i att- - .i . : i is w.� on • ter •(s). •w . •T �"I's ar- Slate: J 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 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 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 inspectio .Access and right of entry to this property shall be requested and shall occur only during regular business hours. /l -- j Signature: Date: V� kG� L 1\ r ZC0 j, ice' 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 wi h the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual nd non-transf le, ponsibility for ad er ig to and co lying with the ESA. 1 ne Applicant has read this disclaimer and signs and dates it belo . �t g (Si nature: Date: t'L r( ,1 2-? 1 2 C%'°k G:\PemtitCenter\FORMS\DRD FORMS\Master Pemut Application 7-8-04.doc 5 0 O'vY NER BUILDER STATEMEN t • 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 MANUFAC URED HOME INSTALLER: PHONE: 7� -7 FAX: K, #''"s (360 ) 30y� / ( ) MAILING ADDRESS: ( 7 'S3 Il / ,�/. EMAIL: CONTRACTORS LICENSE WAINS NUMBER: (5-41 `I f HP y< 67 7 Q 13 NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type i New ❑ Wood Existing: ❑ we Sewage Disposal: Addition ❑ Steel Proposed: Bank ❑ Community System ii Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# I,3nrlrot- Water R..• u D011161UOr1 ❑ Gthei: i/�ater Supply: . Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: l3 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: [1 Underground Tank ❑ Above ground Tank 1-C.. G/4S Size of Propane Tank: , i' Heat Stove I . Cook Stove C1 i/lloodstove X Fireplace limiest I 1 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 su unit 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, includin. the reserve area. S•uare Foota s e For Office Use Only _ Current Pro•osed Amount Main Floor Consistency Review: 2""Floor - ---- Base fee: �J \(_ 4 t_ { 3t. Floor Additiorial Section: , Mezzanine: Plan Check fee: Heated Basement State Surcharge fee: Unheated Basement Pot Water Review fee: Other Unheated 911/Rc \pproach fee: - Garage/Carport - - - TOTAL: $ )( ( .Y Decks /�----- - Receipt Number: / - Other Cash/Check Number: ) • `�t - ESTIMATED COST(REQUIRED) Date: a t . .1=air market value of all labor and materials foundation to finish • � /,1)f j tf- Initials: s . - --- \1'ermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc