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Home My WebLink AboutBLD2007-00086 • • 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 #: BLD07-00086 Received Date 3/7/2007 SITE ADDRESS: 252 BLUEBERRY HILL DR Issue Date 3/7/2007 QUILCENE, 98376 APPLICANT: GARY G WILLIAMS PHONE: 360-765-0736 MARILYN S MITCHELL 252 BLUEBERRY HILL DR QUILCENE WA 983769667 8 SUBDIVISION: BLUEBERRY HILL LARGE LOT Block: Lot: PARCEL NUMBER: 601105008 Section: 10 Township: 26N Range: 01W CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/7/2008 OWNER, GARY G WILLIAMS PHONE: 360-765-0736 if different: MARILYN S MITCHELL 252 BLUEBERRY HILL DR QUILCENE WA 983769667 PROJECT DESCRIPTION: INSTALLING A/G 250 GAL PROPANE TANK WITH GAS LINES TO GENERATOR 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 3/7/2008. REQUIRED INSPECTIONS: Tank/Line/Appliance:As ' 3/Z17 LX r ,�/,t)� �A" 3/L/7/1 FinalApproval: dK 4-1))Y12/ ,3`/2 /D7� 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 BLD07-00086 WILDING PERMIT APPLICAN Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00086 Received Date: 3/7/2007 SITE ADDRESS: 252 BLUEBERRY HILL DR QUILCENE, 98376 OWNER: GARY G WILLIAMS PHONE: 360-765-0736 MARILYN S MITCHELL 252 BLUEBERRY HILL DR QUILCENE WA 983769667 BLUEBERRY HILL LARGE LOT SUBDIVISION: Block: Lot: 8 PARCEL NUMBER: 601105008 Section: 10 Township: 26 N Range: 01 W CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN"*9790Z Expires 9/7/2008 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP INSTALLING A/G 250 GAL PROPANE TANK WITH GAS LINES TO GENERATOR 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: Type Amount Paid By: Date: Receipt: Approved/Date Permit $153.00 DJK 03/07/07 87239 Total: $153.00 �4'�S `l� mat, "JEFFF ONliUNTY • a, r :,: -I R II&ABA._F D "._;,(��= ..� ti IA DEPARTMENT OF COMMUNITY DEVELOPMENT 1 621 Sheridan Street • Port Townsend •Washington 98368 MAR 0 7 2001 360/379-4450 • 360/379-4451 Fax \gS, NG20� www.co.jefferson.wa.us/commdevelopment\ .,..,... IY�U��100�J0�J Master Permit Application .�tkktH�UMLA: . Project Description (include separate sheets as necessary): AO,714-U—A-1—) dti/ p F >4 t3t.t1. 6cou to o z' c 6 Apt. • PR 6 PPIN 7N lc L) nFs 'Tb G EWER_ A-i orb Tax Parcel Property Number: 6 0] I L) 5 CO g" Size: ,S AGE (acres/square feet) Site Address and/or Directions to Property: a s a. a/ e Q t�2.29 +4-(.U-- Ii.?--- qua c,ctl E- (-JP' G ' 3-7) Property Owner(s)of Record: t ,A2L \Ai) LL),ft M S 1 A4 AR_(Ly A..) M t TC.M L(L_ 6' Telephone: (3/ 'RAPS— 67 tp Fax: (31e(i) 7/o r— (Di 3y- email: pis eh)+6-,n ,)y Ae,-,. OD ry-4 Mailing Address: c 5 a utt' CV-r7a 1 *-i 1 LL DQ l tJ ----- Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: WINat kind of Permit? (Check each box that applies \ lBuilding 0 Variance(Minor, Major or Reasonable Economic Use) IDemolition Permit 0 Conditional Use[C(a), C(d),or C]** ❑ Single Family ❑ Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home 0 Modular 0 Special Use(Essential Public Facilities)** O Commercial* 0 Boundary Line Adjustment ❑ Change of Use Cl Short Plat** O Address 0 Road Approach 0 Binding Site Plan** ,❑J-lome Business 0 Cottagelndustry 0 Long Plat** '0 Propane ❑ Planned Rural Residential Development(PRRD)/Amendments** 0 Sign ❑ Plat Vacation/Alteration** 0 Allowed"Yes" Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions** 0 Stormwater Management ❑ Shoreline Management Substantial Development** 0 Site Plan Approval Advance Determination (SPAAD)* 0 Shoreline Management Variance ❑Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication * ❑ Jefferson County Shoreline Master Program Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium ❑ Tree Vegetaion Request *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. Staffs access and right of entry will oe assumed unless the applicant informs the County in writing at the time of the application that he or she wants prior notice. 2 /� Signature: Y�,Qn.,:Qi ,�y -� `-yr-('d 1k /� 3 Date: • • 0 7 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:----)0h. fJ k C,Aa0,_ Date: 3 • 7• (T7 G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc _ _._ BUILDER STATEM— ENT The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not IsCi¢nt7a�tlpr��c�tE they will be assuming the responsibility of the General Contractor for the proposed project. �i\,. ii�dJ1i Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: Rs -�L=� Chin,A IN -, ( 3) -792- 4,S (IffilissohaioNpow MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: New ❑ Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank 0 Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: 0 Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well 0 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: i Underground Tank 1 Above ground Tank Size of Propane Tank: -ZS O G4 L Lunt. i Heat Stove i C ok Stove iWoodstove i Fireplace Insert Hot Water Tank i Pellet Stove7(Other .Ltvvua , 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 bui ings,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: I 53 Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL 13 Decks 911/Rd Approach fee: Other TOTAL: $ 153 Receipt Number: d /2.Sc1 Cash/Check Number: V to \ ESTIMATED COST(REQUIRED) Date: 3 ,-, -O� .Fair market value of all labor and materials foundation to finish i Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc P -, e__ / C2S -C ' '------) T.3 i m I m '� r C ' \ IV i \ 747) i C � m SO 0 73 N �e ( (Nor> . . .... ii, m , ry 0 E_, c----- r r rn v � n 8 1 1� -?. 3 \ \ z m m (' v Z. m z F o H . z m z c c CO �l O \\\) )11i 6c m cn z 73 13 z o v 2. 0 c - ' d rti cN V t a ....t .._ i D ...i1 of J