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Home My WebLink AboutBLD2007-00587 • • 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 #: BLD07-00587 Received Date 11/26/2007 SITE ADDRESS: 111 W VANCOUVER DR Issue Date 11/26/2007 PORT TOWNSEND, 98368 APPLICANT: LACY TRUST PHONE: 360-385-0604 CAPE GEORGE 111 W VANCOUVER DR PORT TOWNSEND WA 983688916 4-5 SUBDIVISION: CAPE GEORGE COLONY DIV 6 Block: 13 Lot: PARCEL NUMBER: 939301303 Section: 12 Township: 30N Range: 02W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2008 OWNER, LACY TRUST PHONE: 360-385-0604 if different: CAPE GEORGE 111 W VANCOUVER DR PORT TOWNSEND WA 983688916 PROJECT DESCRIPTION: A/G PROP TANK SWAP-OUT, 250 GAL TO A 500 GAL Directions SEE MAP& DIRECTIONS IN FILE To Site: 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 11/26/2008. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: /J4/0<..�/2-P-47 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 0587 WILDING PERMIT APPLICATION Review Type: Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00587 Received Date: 11/26/2007 SITE ADDRESS: 111 W VANCOUVER DR PORT TOWNSEND, 98368 OWNER: LACY TRUST PHONE: 360-385-0604 CAPE GEORGE 111 W VANCOUVER DR PORT TOWNSEND WA 983688916 CAPE GEORGE COLONY DIV 6 SUBDIVISION: Block: 13 Lot: 4-5 PARCEL NUMBER: 939301303 Section: 12 Township: 30 N Range: 02 W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2008 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI' A/G PROP TANK SWAP-OUT, 250 GAL TO A 500 GAL TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2006 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: 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 $102.00 AMS 11/26/07 95443 Total: $102.00 0 • SITE VISIT REPORT (PLOT PLAN) JOB t—O-Cy DATE : r CONTACT: ADDRESS I 1 A ' i ., 'A . rA 1 `1° 94"ir + ' PHONE #: DIRECTIONS`— ' - i .Z. r , ' - a.' I• AX #: � • A w it, 4}-o . + L .• Email ,)PLANNER: ?coS)Vt1,4 ,s_ 4�� Q 1 v . rri `.- (YM 1 ?Kos r .i D REC JR II , .¢, ox 006 JEFFERSON WUNTY 'w \ ,� DEPARTMENT OF COMMUNITY DEVELOPMENT _ NOV 2 6 2007 w `J '4\ s, KI 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax Is zoo www.co.jefferson.wa.us/commdevelopment JEFFERSON COUNTY[TGD ztiNex Master Permit Application MLA: Y'lo mlla req Id Project Description include separate sheets as necessary): 4-17-)V1,-.e___ (7-- --n--WL p o--:-L fr ciWA cam. ca J`JO 9-7.1/4._ . Tax Parcel Property 93 9 -3�/ Number: 3 O3 _ Size: (acres/square feet) Site Address and/or Directions to Prooertv: /// W. 1�a v A �. c( (-7. . i Property Owner(s) f Record: , c)- . h j ,7( Z.-4 GLf Telephone: 5 O 6 O Fax: / email: Mailing Address: -5-C Applicant/Agent(if different from owner): S U-N,S H I N E P Ro PA N E Telephone: 385-57 9 7 Fax: 38S.- 5-0'7S email: fN Fc SUn15N/NE ProP e• Mailing Address: 10853 RHovy D 2- � �P i NFi-O t-ock, l.O A- 9 833 ern 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 CI** ❑ Singie Family 0 Garage Attached i Detached ❑ Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home 0 Modular ❑ Special Use(Essential Public Facilities)** ❑ Commercial* 0 Boundary Line Adjustment ❑ Change of Use 0 Short Plat** ❑ Address 0 Road Approach ❑ Binding Site Plan** ❑ Home Business 0 Cottagelndustry 0 Long Plat** Propane 0 Planned Rural Residential Development(PRRD)/Amendments** ❑ Sign 0 Plat Vacation/Alteration** ❑Allowed"Yes" Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions** ❑ 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 0 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 S�l tJS N I NE ,-t1 0 p �_to act as my agent in matters relating to this appli tion for permit(s). ~ WNER SIGNATURE 3' ' �/ �Z e-t ('Date: ��/ � By signing this application form,the owner/agent attests t t 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 C.Cf7 review and any required later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the applicatio that he or she want rior n Ignature: ( ec .cf.;- CDate: ) 4 /`7----/c T- The action or actions Applicant will undertake as a result o 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-ransferable responsibility for heri g to and complying with the ESA. The Applicant has read this disclaimer and si ns and dates it below. Signature: / Date: " i•./O >— G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc l • • BUILDER STATEMENT - The signer of this statement does hereby sertifv 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: SOI4.214 iINIE Pt o pane (360) 3s5- 57T7 ( 360) 385-587- MAILING ADDRESS: 1 0 853 -1-00 y 11 l U & f• IL EMAIL: l n' (0),S(,(V1sf1i 1e. Pro Pane 6 C c '\ CONTRACTOR'S LICENSE 1 WAINS NUMBER: ' UV\S P+ a77Q P 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: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: 0 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 Ta For AppUasi Installation permit,mark all items below that apply: 1 Underground Tank Above round Tank Size of Propane Tank: O Gfl L - 1 H• eat Stove 1 Cook Stove 1 Woodstove I Fireplace Insert 1 Hot Water Tank 1 Pellet Stove 1 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. {;- 5 z .i. - Sax 7� a 3 fd ixx "` P . Square Footage Current Proposed etW: e-O' 1 6,.. Main Floor Heated " ''�,4: 4 EH Bld App Review: r 2na Floor Heated 'k,,' ConsistencyReview: Other Heated fl Base fee: � 4 I Mezzanine ' k p Additional Section: Heated Basement `(' Plan Check fee: Unheated Basement r.,: State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Decks 1 .` 911/Rd Approach fee: Other TOTAL: $ 10 a ° ,.•. - -�r Receipt Number: CC L r Cash/Check Number: 3C1 ESTIMATED COST(REQUIRED) Date:•Fair market value of all labor and materials foundation to finish i 1 acda-1 Initials: t. G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc