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Home My WebLink AboutBLD2008-00213 • 0 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 #: BLD08-00213 Received Date 5/20/2008 W SITE ADDRESS: 276875 HY 101 #75 Issue Date 5/20/2008 GArD, wc-, WA 5S38a, APPLICANT: LORETTA DATE PHONE: (206) 715-3517 2261 OLD GARDINER RD SEQUIM WA 98382 SUBDIVISION: Block: Lot: PARCEL NUMBER: 002353003 Section: 35 Township: 30N Range: 02W CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTPI983O6 Expires 9/26/2008 OWNER, DISCOVERY BAY LSEHLDRS ASSOC PHONE: if different: 2261 OLD GARDINER RD SEQUIM WA 98382-8718 A) 12c� C�F1 t— PROJECT DESCRIPTION: INSTALL/PROPANE TANK AND GAS PIPING Directions SEE GOOGLE MAP AND 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 5/20/2009. REQUIRED INSPECTIONS: Tank/Line/Appliance: --47,----CrIti FinalApproval: �7 - Z7? "CC 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 INUILDING PERMIT APPLICAIN BLD08-00213 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD08-00213 Received Date: 5/20/2008 SITE ADDRESS: 276875 HWY 101 #75 G ��D� ter WA g8382. f4.1e C, OWNER: DISCOVERY BAY LSEHLDRS ASSOC PHONE: 2261 OLD GARDINER RD SEQUIM WA 98382-8718 SUBDIVISION: Block: Lot: PARCEL NUMBER: 002353003 Section: 35 Township: 30 N Range: 02 W CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTP198306 Expires 9/26/2008 REPRESENTATIVE: LORETTA DATE PHONE: (206) 715-3517 2261 OLD GARDINER RD SEQUIM WA 98382 PROJECT DESCRIPTION INSTALLiPROPANE TANK AND GAS PIPING 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 $105.00 KAS 05/20/08 100214 Total: $105.00 ��.�,goN OOd JEFFERSOOUNTY 14401:44 DEPARTMENT OF COMMUNITY DEVELOPMENT .1 `� -�'�'[� AT ED 621 Sheridan Street • Port Townsend •Washington 98368 IT 360/379-4450 • 360/379-4451 Fax ,0 www.co.jefferson.wa.us/commdevelopmeit err 11AY 2 0 20U$ Master Permit Application MLA: { Project Description(include separate sheets as necessary): , L,.., t+L_ /41T, LL "RC ig,V6 7720411) (2'415LIN6 _ . Tax Parcel Property Number: GG? 3S.34D3 _ Size: //4'ay hi2� Sq, �Z' (acres/square feet) Site Address and/or Directions to Property: 4>/4 6/0ARt&te27' Lvf 7S Discda&-,9, goy �PEsog ,?76 87S fiu id/ S- Property Owner(s)of Record: LDREE/rof Vi4?'d Telephone: rgeL 7/.0 ?.Si 7 Fax: email: I eQi VaTA- L,� Mailing Address:226/ C)G0 G p t 6 P. s 9ui iyf 9F 372 K! 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 0 Garage Attached/Detached 0 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** IC Propane ❑Planned Rural Residential Development(PRRD)/Amendments** Sign 0 Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis ❑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 ❑Tree Vegetation 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 c .:/. i'.. t/ /Th to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE—✓7 (/9r. XT � r�19,QK ///l • Date: /2c/tf By signing this application form,the owner/a ent attests that the information provided herein,and in any attachments,is true and correct to the best of his, her or its 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 to assumed unless the applicant informs the County in writing at the time of the application tha h or e want prior notice. Q ,jC/ Na,ignature: ( . SEX TON �S.r%.// } Date: s/1A/61? 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 ccde.The Applicant acknowledges that he,she or it holds individual and non-transferable r p nsib. ty for adhering to and complyin with the ESA. he Applicant has read this disclaimer a signs and dates it below. (Al,Signature: CK/ SXTo� v� ,Ss'?.I4W Oa . Date: �12.0008 G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc b. • 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: /flauv m,v OCAVe S1h )693 /ley/ ( ) 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 ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ Repair Cl Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Typ of Heat: Proposed: ❑ Public �fieoQ4N6 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 CAboveground Tank) Size of Propane Tank: /a() �„fix,,,,„,, i Heat Stove i Cook Stove 1 Woodstove 1 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. 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: �T vt{tit( I Caif- Mezzanine , Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: , Other Unheated a. Pot Water Review fee: Garage/Carport . .` SUBTOTAL l05.b() Decks 911/Rd Approach fee: Other TOTAL: $ In oc) Receipt Number: L U r),' tic Cash/Check Number: Lt ESTIMATED COST(REQUIRED) Date: �I��I Uc •Fair market value of all labor and materials foundation to finish 1 l Q Initials: C G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc , o rn n m oa N wa L1z w o m W I O m 'N v C.y F3, \. ) vf) ______--- ----, Ao Iv E \ ri h GI rn gZ m 4-g -tiy t IA tit 12 14,i_c / 4,,z � 1 .may I: & 3 m 3. \\i'ci\ k 8 -s, P,Mie)/7 - 1 c 1. 1 _� NA -p c C1Um m`r .a % • II We V � 0 ,--- l m ` � -0 � r X Z :- k k o A �\v � rc CI 4% , 0., i ' \a Z * rf lk o NI �� 0 �.