The URL can be used to link to this page

Home My WebLink AboutBLD2006-00390 • • 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 #: BLD06-00390 Received Date 7/12/2006 SITE ADDRESS: SNOW CREEK RD Issue Date 7/13/2006 QUILCENE, 98376 APPLICANT: KATHY KEIGHTLEY PHONE: 360-765-6495 2583 SNOW CREEK RD QUILCENE WA 983769530 SUBDIVISION: Block: Lot: PARCEL NUMBER: 802221004 Section: 22 Township: 28N Range: 02W CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/7/2006 OWNER, KATHY KEIGHTLEY PHONE: 360-765-6495 if different: 2583 SNOW CREEK RD QUILCENE WA 983769530 PROJECT DESCRIPTION: A/G 250 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 7/13/2007. REQUIRED INSPECTIONS: Tank/Line/Appliance: 17i/A4 9'L 1IkQ,(91 '0`06 FinalA val: (��/27 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 ILDING PERMIT APPLICATI N BLD06-00390 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00390 Received Date: 7/12/2006 SITE ADDRESS: SNOW CREEK RD QUILCENE, 98376 OWNER: KATHY KEIGHTLEY PHONE: 360-765-6495 2583 SNOW CREEK RD QUILCENE WA 983769530 SUBDIVISION: Block: Lot: PARCEL NUMBER: 802221004 Section: 22 Township: 28 N Range: 02 W CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/7/2006 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIO1, A/G 250 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: SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: 0TE-D -1 I I31()t0 &r CZ Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $51.00 LYK 07/12/06 83770 Total: $51.00 k�4�4, °N coe„ JEFFERSOSOUNTY T �q�'� y \g + r3 DEPARTMENT OF COMMUNITY DEVELOPMEl4 -4 J it�'' ! 1�.►' `4 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax �gS,IIIN��O$ www.co.jefferson.wa.us/commdevelopment1 z, "j Master Permit Application JEFFERSON MtL ► 1 flE O II'VL A G" D Project Description (include separate sheets as necessary): Property (�, Tax Parcel Number: >�Q„2,2, /�0`f Size: b a c(es (acres/square feet) Site Address and/or Directions to Property: a "J 7 $ f.. , Ceee Ad 42 ,l cL- ? I l�4 Property Owner(s)of Record: f; •�.tli� /vec cf. Li p</G/ Telephone: 3(00 7(p$ —a,f 2 - / Fax: ✓ email: Mailing Address: Sgvt.4 g a S �..,( q„,,v Applicant/Agent(if different from owner): GA eel GdY1-+iv! Telephone: 5 a 4-1,e Fax: j email: Mailing Address: c-6/01e. Whit 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 Cj** ❑ 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 C_1 Road Approach C] Planned Rural Residential Development(PRRD)/Amendments** ropane ❑ Plat Vacation/Alteration** ❑Allowed"Yes" Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions** ❑ Stormwater Management Cl Shoreline Management Substantial Development** ❑ Site Plan Approval Advance Determination(SPAAD)* CI Shoreline Management Variance ❑ Temporary Use CI 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 re ed later inspectio .Access and right of entry to this property shall be requested and shall occur only during regular business hours. �%�/LLJ`. �Signature: Date: —7/// �C' 2 The action or actions A licant will ///pp 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 Jeffe o County development code.The Applicant acknowledges that he,she or it holds individual and non- transferable responsibifit or adheri g to omplying with the ESA. The Applicant has read this disclaimer and sig andgates it below. Signature: y � �� Date: 7 ' G2/4j G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc l • 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 C NTRA TOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: 5e( I'0 -d, , (P ,p- ( ) ( ) MAILING ADDRE S: S . . 14-0 t.t/Cie,/,-`��J EMAIL: CONTRACTOR'S LICENSE ,{ ) / WAINS NUMBER: (�"L`lG-914 (�/� NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New C17Wood Existing: f Li Sewer ❑ Addition [1 Steel Proposed: Bank Height: ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: IiPrivate well i 1 Two Party Type of Heat: Proposed: Li 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 an r Appliance Installation permit,mark all items below that apply: / 1 i Underground Tank bove ground Tank Size of Propane Tank: ` 11 Heat Stove I I Cook Stove 1 1 Woodstove I1 Fireplace Insert 1 i 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 Current Proposed For Office Use Only Amount Revision Main Floor Heated EH Bld App Review: 2nd Floor Heated Consistency Review: $9 5. 50 Other Heated Base fee: I 0 0 Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: $ 7 /_ 5d Receipt Number: g 3--f 0 Cash/Check Number: CkSk. ESTIMATED COST(REQUIRED) Date: II Z'I� •Fair market value of all labor and materials foundation to finish Initials: CZ- G:\PermitCcnter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc