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Home My WebLink AboutBLD2006-00358 • • 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 #: BLD06-00358 Received Date 6/26/2006 SITE ADDRESS: 113 MATS VIEW TERRACE RD Issue Date 6/26/2006 PORT LUDLOW, 98365 APPLICANT: MICHAEL L FULLER LAUREEN J FULLER PHONE: 253 797 6845 113 MATS VIEW TER PORT LUDLOW WA 983659462 SUBDIVISION: MATS VIEW TERRACE 4 Block: Lot: PARCEL NUMBER: 970900004 Section: 5 Township: 28N Range: 01E CONTRACTOR: ALL ABOUT GAS INC PHONE: 360-681-5474 970 RIVER RD SEQUIM WA 98382 Contractor's License ALLABAG9510T Expires 9/30/2007 OWNER, MICHAEL L FULLER PHONE: 253-797-6845 if different: LAUREEN J FULLER 113 MATS VIEW TER PORT LUDLOW WA 983659462 PROJECT DESCRIPTION: A/G 100 GAL PROP TANK - NO MLA REQ'D 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 6/26/2007. REQUIRED INSPECTIONS: Tank/Line/Appliance: hatOZoon. L.Ns OK - kec.Ario i OI< 6/29/06 FinalApproval: D� -�'or -( Nam/ ?/4/6 Al 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 RILDING PERMIT N APPLICATI BLD06-00358 � Jefferson County Department of Community Development Review Type: 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00358 Received Date: 6/26/2006 SITE ADD RE SS: 113 MATS VIEW TERRACE RD PORT LUDLOW, 98365 OWNER: MICHAEL L FULLER PHONE: 253-797-6845 LAUREEN J FULLER 113 MATS VIEW TER PORT LUDLOW WA 983659462 MATS VIEW TERRACE SUBDIVISION: Block: PARCEL NUMBER: 970900004 Section: 5 Township: 28 N Range: 01 E Lot: 4 CONTRACTOR: ALL ABOUT GAS INC 970 RIVER RD PHONE: 360-681-5474 SEQUIM WA 98382 Contractor's License ALLABAG9510T Expires 9/30/2007 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION A/G 100 GAL PROP TANK - NO MLA REQ'D 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: Routin. Date: C , Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $51.00 LYK 06/26/06 8:3630 Total: $51.00 .,?...SON co 0 JEFFERSO OUNTY r � tii \g DEPARTMENT OF COMMUNITY DEVELOPMENT i` r i_� F.,,,, `'4 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax JUN 2 6 2006 Is, INC www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: c7 tlIt,k � )) Project Description(include separate sheets as necessary): v37 AlL -/I�f/ 7.4E- d34x.1% I- l.i�r,�s /}Brvt_Apusbc lOz2 114he 1L7_-4 Property Tax Parcel Number: %�z% gc;00 -44 �nI rj / �' Size: (� // ',, ((acres/square feet) Site Address and/or Directions to Property: /0 /3T.S L�!l A' J 1 emcp,2�) 2A I Li V i.o) i il 90 360r Property Owner(s)of Record: iC.►+f`{eL - J /r24 r�D_ � l)_r J5 Telephone: g 3 797-ot s3 2.5' Fax: email:}r = f Sp4 E-i, Mailing Address: 3 AIM c Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies) ❑ Building 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit 0 Conditional Use[C(a), C(d),or C]** ❑ Single Family ❑ Discretionary"D"or Unnamed Use Classification ❑ Garage Attached/Detached 0 Special Use(Essential Public Facilities)** ❑ Manufactured Home ❑ Boundary Line Adjustment 0 Modular 0 Short Plat** ❑ Commercial* ❑ Binding Site Plan** ❑ Change of Use ❑ Long Plat** 0 Address I I Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** Propane 0 Plat Vacation/Alteration** 0 Allowed "Yes"Use Consistency Analysis Cl Shoreline Master Program Exemption/Permit Revisions** 0 Stormwater Management 0 Shoreline Management Substantial Development** ❑ Site Plan Approval Advance Determination (SPAAD)* 0 Shoreline Management Variance ❑ Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑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: VA DESIGNATION OF AGENT I hereby designate to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: 6 � o4 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 requir later inspections. ccess and right of entry to this property shall be requested and shall occur only during regular business hours. Signature: j - o�Date: 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 respo s' for adhering d ying with the ESA. The Applicant has read this disclaimer a signs a d dates it below. Signature: 1�� _ Date: � a G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc • • 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 assumin responsibility oft ener Contractor for the proposed project. Signature: Date: • —e9 -6 GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: very o z ) L 8/ -5 17" i ( ) MAILING ADDRE S: 970 1 I, 1 h p Uix4 MA EMAIL: CONTRACTOR'S LICENSE 91,E;$2.WAINS NUMBER: Q`fr�j.I&A Q 5/'J,L Or NUMBER ARCHITECT/ENGINEER: I ' PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: )4N New alr Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank Height: ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: _ ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: I I Private well ❑ Two Party Type of Heat: Proposed: Li Public Lie&TRIe_ 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 X,Above ground Tank Size of Propane Tank: , ';, i ! Heat Stove X Cook Stove I I Woodstove [I Fireplace Insert , Hot Water Tank [I Pellet Stove I I 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 Current Proposed For Office Use Only Amount Revision Main Floor Heated EH Bld App Review: - 2nd Floor Heated Consistency Review: Other Heated Base fee: DiT 1 f,, Mezzanine Additional Section Heated Basement Plan Check fee: - Unheated Basement State Surcharge fee: _-- Other Unheated Pot Water Review fee: _ Garage/Carport SUBTOTAL 1-7 Decks 911/Rd Approach fee: _____-- Other TOTAL: $ ' --1 Receipt Number: ' („ Cash/Check Number: ESTIMATED COST(REQUIRED) Date: �� •Fair market value of all labor and materials foundation to finish ID Initials: G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc 71 f n -... — ' ' I . I IS ' . 0 r1,) ..1 7Iv- \ . , • .•••••/....„,„... \ '.!6\ V4's ..... 1 Z. \ \\ ‘, 7 . 44 ,i. 1 r ri \ \ . . ( -‘011 ---- — -' '-::/\/- 7. 0 . 1 d 0 -Tr,. il.. '-.':-' (ez.l' -,f \ ---- ) ' \.. 1-5 6*1 .. *:,'..: qi -3 Z. C/i.v 1 ,.._ ,, ,_-.e..!,. .„ ' , k - . •41. Cr>i- .." -1. 9. 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