HomeMy WebLinkAboutBLD2009-00178 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 #: BLD09-00178 Received Date 6/18/2009
SITE ADDRESS: 141 LAKEVIEW DR Issue Date 6/18/2009
QUILCENE, 98376
APPLICANT: MARILYN J BROWN PHONE: 360-765-3388
CLARENCE E BROWN
141 LAKE VIEW DR E
QUILCENE WA 98376-9516 21
SUBDIVISION: SNOW CREEK RANCH Block: Lot:
PARCEL NUMBER: 995400020 Section: 1 Township: 28N Range: 02W
CONTRACTOR: THURMAN SUPPLY PHONE: 360-457-8591
1807 E FRONT ST
PORT ANGELES WA 98362
Contractor's License THURMS*954JA Expires 11/26/2010
OWNER, MARILYN J BROWN PHONE: 360-765-3388
if different: CLARENCE E BROWN
141 LAKE VIEW DR E
QUILCENE WA 98376-9516
PROJECT DESCRIPTION: NEW PELLET STOVE
Directions
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 6/18/2010.
REQUIRED INSPECTIONS:
Tank/Line/Appliance:
FinalApproval: (Z- -{ f
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
BLD09-00178
UILDING PERMIT APPLICA•N Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD09-00178 Received Date: 6/18/2009
SITE ADDRESS: 141 LAKEVIEW DR
QUILCENE, 98376
OWNER: MARILYN J BROWN PHONE: 360-765-3388
CLARENCE E BROWN
141 LAKE VIEW DR E
QUILCENE WA 98376-9516 SNOW CREEK RANCH
SUBDIVISION: Block: Lot: 21
PARCEL NUMBER: 995400020 Section: 1 Township: 28 N Range: 02 W
CONTRACTOR: THURMAN SUPPLY PHONE: 360-457-8591
1807 E FRONT ST
PORT ANGELES WA 98362
Contractor's License THURMS*954JA Expires 11/26/2010
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION NEW PELLET STOVE
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 $146.00 LYK 06/18/09 108622 \IDpRVE[)
Total: $146.00 ��
JUN ICE 2009
Jefferson County Planning
&Building Department
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JUN 1 8 2009
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ri,,,,ern‘v• JEFFERSON A UNTY
3 DEPARTMENT OF COMMUNITY DEVELOPMENT
$*' R ' `4 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
,/,.. ywww.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: K C P1A_A `is
Project Description(include separate sheets as necessary):
i�//��,. 3/z,i-e 114 /a. 2�4,z,
Tax Parcel Number: '9 3' S y 0007.. n Property Size:
G1 (acres/square feet)
--- Site Address and/or Directions to Property:
i.
it /� L u eta e, -e y calf !.-,al -P vt-c ;
Property Owner(s)of Record: `^ou,U/
Telephone: 74 S-33 j'' Fax: email:
Mailing Address: / l'1 /,Cl, f V f.,S rOi„
Applicant/Agent(if different from owner): i I'- 1 et.,14 S (4 /f(-bi-P ei s?' g? 2 P.
Telephone: ice,n 7- 5 9�Fax: email:
Mailing Address:�/�{O'7 .8.g l-,o� oy, 41-7 c,,J��5 ( ) et V 3 G, 2,
hat kind of Permit?(Check each box that applies ❑Lot or Road Segregation
Building El Critical Areas Stewardship Plan
0 Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use)
❑ Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a), C(d),or C]**
i ❑ Manufactured Home .❑ Modular 0 Discretionary"D"or Unnamed Use Classification
0 Commercial* 0 Special Use(Essential Public Facilities)**
❑ Change of Use 0 Boundary Line Adjustment
0 Address 0 Road Approach ❑ Short Plat**
❑ Home Business 0 Cottage Industry ❑ Binding Site Plan**
0 Propane ❑ Long Plat**
❑ Sign •- 0 Planned Rural Residential Development(PRRD)/Amendments**
0 Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration**
0 Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions**
❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development**
0 Temporary Use 0 Shoreline Management Variance
0 Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment
*May require a Pre-Application Conference ❑Tree Vegetation Request
**Requires a Pre-Application Conference
Please identify any other local,state or federal permits required for this proposal, if know:
JUN 1 g 2P"
DESIGNATION OF AGENT
'-I hereby designate 1.--riA,vj�� i/f s' to act as
_ � my agent in matters relating to this application for permit(s).
OWNER SIGNATURE ( �/J /�,,,
Ca t° Dy/g ' ...L. -o - ( Date: i:- '7 • P-)
By signing this application form the owner/agent attests-the information provide
d d 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 be assumed unless the applicant informs the County in writing at the
time of the application that he or she wants pri otice.
Signature: 7 Aplicar. > 2
�( d 01 Date: - /7 > `I
The action or action pnt will�underta s a result of the issuance of this permit
may or
endangered species and could lead to a potential"take"of an endangered species as those terms vare defined inely impactothe federal law known as one or more threatenen 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 adherin nd co ng with the ESA. The Applicant has read this dislaimer and signs anc(dates it below.
Signature:
1 (P! �. 72a Date: �J` 17-- O 4'
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G:\PermitCenter ###F S#l##\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
• • N
BUILDER STATEMENT
The signer of this statement does hereby bertify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and Chat
they will be assuming the responsibility/tif the General Contractor for the proposed project.
/, / / j Date: (c r 7 O
—'Signature: / `,t, f,.,,,/' `
Fax:
GENERAL-C ts1TRACTOR OR MANUFACTURED HOME INSTALLER: PHONE:
(so) y/S 7- $( / (;u�) 15� 1 ya,"
�� �/� 1n % / r
MAILI tip
/yo7 .7<f j h �j,�: j h(r-J- 2Lt y�j,�.4_3 EMAIL:
CONTRACTOR'S LICENSE ftj�t."44J 'iC` ? t7ll+••k WAINS
NUMBER: A//f NUMBER
ARCHITECT/ENGINEER: Al4PHONE ( ) FAX:( )
MAILING ADDRESS: V EMAIL
Project Type: Type:Frame T e Bathrooms: Shoreline: Type of Sewage Disposal:
New 0 Wood Existing: ❑ Sewer
❑ Steel Proposed: Bank ❑ Community System
❑ Alterati
❑ Additionaion/Remodel ❑ Concrete Total: Height: ❑ Individual System
— SEP Permit#
❑ Repair ❑ Masonry
❑ Other: Bedrooms: Water Supply:
❑ Demolition Existing: Setback: 0 Private well ❑ Two Party
Proposed: ❑ Public
Type of Heat: 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:
1 Underground Tank 1 Above ground Tank Size of Propane Tank:
1 Heat Stove 1 Cook Stove 1 Woodstove 1 Fireplace Insert I Hot Water Tankellet 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 I Current Proposed For Office Use.Only Amount Revision
Main Floor Heated EH Bld App Review:
2`d Floor Heated Consistency Review:
Other Heated Base fee: i Ltp
Mezzanine Additional Section: l
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee:
Other Unheated
Pot Water Review fee:
Garage/Carport SUBTOTAL
Decks 911/Rd Approach fee:
Other TOTAL $/y6 30
Receipt Number: I CACOZ2
Cash/Check Number:
SW—
ESTIMATED COST(REQUIRED) Date: ��(
.Fair market value of all labor and materials foundation to finish Initials: C/ /Y
(�
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc