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Home My WebLink AboutBLD2008-00002 002 I UILDING PERMIT APPLICAt)N B RDowo Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD08-00002 Received Date: 1/4/2008 SITE ADDRESS: 302 HAADA LAAS RD PORT TOWNSEND, 98368 OWNER: JEFFREY A PEDERSEN PHONE: (818) 448-3751 SUZANNE KNILL 7811 SHADY COVE AVE BURBANK CA 91504-1036 SUBDIVISION: Block: Lot: TX64-1 PARCEL NUMBER: 001062029 Section: 6 Township: 30 N Range: 01 W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2008 REPRESENTATIVE: SUNSHINE PROPANE PHONE: (360) 385-5797 10853 RHODY DR (360) 385-5875 PORT HADLOCK WA 98339 PROJECT DESCRIPTION INSTALL A/G 120 GAL PROPANE TANK, GAS PIPE AND GAS FIREPLACE TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION MAIN: CODE EDITION: 2006 ADD'L: HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: 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 $153.00 KAS 01/04/08 95683 Total: $153.00 I 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 #: BLD08-00002 Received Date 1/4/2008 SITE ADDRESS: 302 HAADA LAAS RD Issue Date 1/4/2008 PORT TOWNSEND, 98368 APPLICANT: SUNSHINE PROPANE PHONE: (360) 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 TX641 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001062029 Section: 6 Township: 30N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 (3 p 3 Contractor's License SUNSHP*077QP Expires 1/367/2008 5875 OWNER, JEFFREY A PEDERSEN PHONE: (818) 448-3751 if different: SUZANNE KNILL 7811 SHADY COVE AVE BURBANK CA 91504-1036 PROJECT DESCRIPTION: INRSETpALLL A/G 120 GAL PROPANE TANK, GAS PIPE AND GAS Directions SEE GOOGLE MAIM iJlI E TIONS 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 1/4/2009. REQUIRED INSPECTIONS: Tank/Line/Appliance —G C FinalApprova1 l -A 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 • • SITE VISIT REPORT (PLOT PLAN) JOB S2 C'- --\ -e� ('S DATE : 11 1 S I ul CONTACT: ADFRESS PHONE #: DIRECTIONS FAX #: Email PLANNER: i A 'k° 7 �� v -I I 0 w O �� 1 l oo ' (\`tip 10) IL V ED BAN - 4 2008 L fFf II,Vio CoU�l,O CO (rike).`'`SINCo JEFFERSONSUNTY 0 RECEIVEDD` .4 DEPARTMENT OF COMMUNITY DEVELOPMENTEl 621 Sheridan Street • Port Townsend • Washington 98368 JAN — 4 2008 '' 360/379-4450 • 360/379-4451 Fax qsNzi- � www.co.jefferson.wa.us/commdevelopment JEFffRSON COUNTY In Master Permit Application MLA: Project Description (include separate sheets as necessary): c ,� • Tax Parcel . 0-r�-� d'-r+k-, 9 - — P- f *P-t- - � 0 / - Q �O 2 _ D� lf Property Number: _ Size: (acres/square feet) Site Address and/or Directions to Property: 0 a?- 4/4 �� L‹. 1 k,) , r:. tie-- Property Owner(s)of Record: -ems/, � s.eJe_,,.� , �G a h t *4'L Telephone: 8/ 8— d'—.3 Fax: email: Mailing Address: ' � // 6o1-*-{ ��- -ect7Qei,../ C'4-_ 9/,..(0 Applicant/Agent(if different from owner: S U..NS H I N E P Ro PA N E Telephone: 395-5-79 7 Fax: 3BS- SS"7S email: INFOSUnjsH/NE prorAt7e, Mailing Address: 1 OQ,53 R HoDy De_ / pr. NuJ W i9 ck LA)A- 9 833'7 .orv, 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]** ❑ Singie Family 0 Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home 0 Modular 0 Special Use(Essential Public Facilities)** ❑ Commercial* 0 Boundary Line Adjustment ❑ Change of Use 0 Short Plat** ❑ Address 0 Road Approach 0 Binding Site Plan** ❑ ome Business 0 Cottagelndustry 0 Long Plat** Propane ❑ Planned Rural Residential Development(PRRD)/Amendments** 0 Sign ❑ Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions** ❑ Stormwater Management 0 Shoreline Management Substantial Development** 0 Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Variance ❑ Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment 0 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) 'I hereby designate Su NS H I N E t RsJ p A-vie_to act as my agent in matters relating to this application for permit(s). WNER SIGNATURE �— (Date: /2 G 01 By signing this applicatio orm,the ow er/a ent 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. 1 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 be assumed unless the applicant informs the County in writing at the time of the application that h r e wants prr n ice. �J ignature: ^�— Date: t `/2,��L'� The action or actions pplicant 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 \ l and non-ransferable resp n ibility for adheri o'nd complying with the ESA. The Applicant has read this disclaimer and signs a dates it below. Signature: 1c-/i`� Date: 1 L/ !i S e.-7 G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc 1: 15-30.-0 • 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 CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: 1 S1iQ4IOC Pk-0 pang (360) 305- 5797 ( 360) 385-5875 MAILING ADDRESS: j 08,53 co' t/ n i U e P. H. EMAIL: I n' 1),,(3,(y\c111V e. Pro P e a C enA CONTRACTOR'S LICENSE l WAINS NUMBER: 51- (154 P+ arTq4 P NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New 0 Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ 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: ❑ 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 I Above ground Tan Size of Propane Tank: /2-o 5,...., ��7 (...i.4 , I Heat Stove I Cook Stove Woo s ove ireaserr, I Hot Water Tank I Pellet Stov 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 rl Ice Use"Only�.s�;G. K� _, n! f kr-1t;�; ARiii kint ,} • 4.!Re' rl wil Main Floor Heated ;N, .V+ {ti, : EH BId App Review: C.yy.p�i 5 F. 2na Floor Heated 44 ' Consistency Review Other Heated .+ Base fee:w nQ 1 ry.) Mezzanine ( -,'u,i�A� E Y Additional Sectio 1 Heated Basement f' ,,.' , Plan Check fee: Unheated Basement JAN - 4 211:; �` . State Surcharge fee: Other Unheated s � _�' Pot Water Review fee: Garage/Carport JEFFERS01 COO I AIi4f SUBTOTAL m Decks j.° 911/Rd Approach fee: Other TOTAL: $ ` 5 CCD-� t Receipt Number: `1�(e) r _, :.. Cash/Check Number: �b ESTIMATED COST(REQUIRED) Date: Op .Fair market value of all labor and materials foundation to finish Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc