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Home My WebLink AboutBLD2008-00301 • • 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 #: BLD08-00301 Received Date 7/3/2008 SITE ADDRESS: 40 FOUR CORNERS RD Issue Date 7/3/2008 PORT TOWNSEND, 98368 APPLICANT: NORMA K BIRCHER PHONE: 360-385-5161 40 4 CORNERS RD PORT TOWNSEND WA 983689366 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001333030 Section: 33 Township: 30N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 ((33 pl 3g5 7/2008 Contractor's License SUNSHP*077QP Expires 11/1 -5875 OWNER, NORMA K BIRCHER PHONE: 360-385-5161 if different: 40 4 CORNERS RD PORT TOWNSEND WA 983689366 PROJECT DESCRIPTION: 120 GAL A/G PROP TANK SWAPOUT- NO MLA REQ'D Directions SEE 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 7/3/2009. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: (n-( /__ BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS. Office Hours 9:00 a.rn. -4:30 p.m. HOT LINE AVAILABLE 24 HOURS A DAY I:\F_BLD_Permit_Propane.rpt 10/29/19 °BUILDING PERMIT APPLICAON BLD08-00301 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD08-00301 Received Date: 7/3/2008 SITE ADDRESS: 40 FOUR CORNERS RD PORT TOWNSEND, 98368 OWNER: NORMA K BIRCHER PHONE: 360-385-5161 40 4 CORNERS RD PORT TOWNSEND WA 983689366 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001333030 Section: 33 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)875 PORT HADLOCK WA 98339 PROJECT DESCRIPTIOI 120 GAL A/G PROP TANK SWAPOUT- NO MLA REQ'D 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 $52.00 AMS 07/03/08 100514 Total: $52.00 SITE VISIT REPORT (PLOT PLAN) JOB J0a,rn DATE : Ce/, 676 e" CONTACT: ADDRESS H 0 `-) - Co tS R PHONE #: DIRECTIONS FAX #: Email PLANNER: R EsS y cot GA-M- Z. 5 4-- P°J 6P t14 CJ� OD )oC 6 i �i¢SON Cfj\ JEFFERSOCOUNTY • e \,� DEPARTMENT OF COMMUNITY DEVELOPMENT "� - 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax ISra www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: O a 6\10 YA6Cild Project pescription(include se arate sheets as necessary): Tax Parcel f�6 / 2 O Property Number: (� ( J Size: (acres/square feet) Site Address and/or Directions to ProDertv: n - Property Owner(s)of Record: / .1 a-c -i e4 rr7----0 Telephone: 33'S --s/6 ( - Fax: email: Mailing Address: _d I f'e_ Applicant/Agent(if different from owner): S u-NS H I N E P R.o PA N E Telephone: 395 5717 Fax: 313S- 5 S'7S email: tr1/41 Fog Sun1SH/NEPfOfA,-ne• Mailing Address: 10853 RHoDy D e• / fir-. 1-tl°rO Lock LA)R- 9 8339 or"t What kind of Permit?(Check each box that applies ❑Building 0 Variance(Minor, Major or Reasonable Economic: '..lse) ❑ Demolition Permit 0 Conditional Use[C(a),C(d),or C]** ;//jr ❑ Single Family 0 Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification 0 ❑ Manufactured Home ❑ Modular 0 Special Use(Essential Public Facilities)* c� ❑ Commercial* 0 Boundary Line Adjustment �ff/f/9❑ Change of Use ❑ Short Plat** ,/ye/Se/�► ❑ Address ❑ Road Approach ❑ Binding Site Plan** G "fjt/n ❑ Home Business 0 Cottagelndustry 0 Long Plat** d Propane ❑ Planned Rural Residential Development(PRRD)/Amendments**' ❑ Sign ❑ Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions** ❑ Stormwater Management ❑ Shoreline Management Substantial Development** ❑Site Plan Approval Advance Determination (SPAAD)* ❑ Shoreline Management Variance ❑Temporary Use ❑ 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: r t_0 cu ffs n� DESIGNATION OF AGENT \N I hereby designate J Ei ICE t Q �_to act as my agent in matters relating to this application '.)r permit(s). ��WNER SIGNATURT YI G1Z/a�12�(I,,I,0.4129 (Date: 7//,f'�a By signing this application form,the owner/agent attests that the mminformation 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 v 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 plic tion that he or she wants prior notice.ig �// / ,,, s---) a e: ntur Date: The action or actio s 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 S\ 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 hc'as individual � and non-rans rable responsibility for adheri t and complying 'th the ESA. The Applicant has read this disclaim,a signs nd it below. Signature: -eAkA/et Date: /0 G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-'19-2006.doc • BUILDER STATEMENT • The signer of this statement does hereby^ertify 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: OQH SiNE P1 opane (� (360) 385- 5797 ( 360) 3B5-5875 MAILING ADDRESS: )08,53 o t/ 1) I ) e- P. H. EMAIL: I n- a)3U✓S1-111►(_ pro Pane 6 C On CONTRACTOR'S LICENSE j WAINS NUMBER: U el t4 P+ OW Q P NUMBER ARCHITECT/ENGINEER: rT PHONE,( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: 0 New ❑ Wood Existing: 0 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: Numbr 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 l(Above ground Tank j Size of Propane Tank: /.2 J I Heat Stove I Cook Stove 1 Woodstove I Fireplace Insert I Hot Water Tank 1 Pellet Stove I 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. 4; 7 r , dS Tk it 4a ' e ', 1 Square Footage Current Proposed '•Fot' ficetUse�Only3 , _r,.�; , , '�, 1�;"T 3Amour t .V, �.. . r.,:.. Main Floor Heated 1.: - EH Bld App Review: 2na Floor Heated 4 -at,,, is Consistency Review: 3 LAW' Y i Other Heated - ' ` Base fee: p t Mezzanine iK, '° a',, Additional Section: Heated Basement , Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: ;7- Garage/Carport SUBTOTAL Decks ; ., '. 911/Rd Approach fee: Other ' TOTAL: $ : L Receipt Number: Cash/Check Number: ESTIMATED COST(REQUIRED) Date: •Fair market value of all labor and materials foundation to finish Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc