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Home My WebLink AboutBLD2009-00315 9 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 1110 PERMIT #: BLD09-00315 Received Date 9/23/2009 SITE ADDRESS: 276875 HWY 101 #106 Issue Date 9/23/2009 SEQUIM, 98382 APPLICANT: DISCOVERY BAY LSEHLDRS ASSOC PHONE: 2261 OLD GARDINER RD SEQUIM WA 983828718 + SUBDIVISION: Block: Lot: PARCEL NUMBER: 002353002 Section: 35 Township: 30N Range: 02W CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTP198306 Expires 9/26/2010 OWNER, DISCOVERY BAY LSEHLDRS ASSOC PHONE: if different: 2261 OLD GARDINER RD SEQUIM WA 983828718 PROJECT DESCRIPTION: SWAP OUT 120 GAL PROP TANK -SAME SIZE & LOCATION 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 9/23/2010. REQUIRED INSPECTIONS: ank/'ine/Appliance:_ FinalApproval: 1 1. t' 1-_ 4 ,c. 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 MILDING PERMIT APPLICATA BLD09-00315 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD09-00315 Received Date: 9/23/2009 SITE ADDRESS: 276875 HWY 101 #106 SEQUIM, 98382 OWNER: DISCOVERY BAY LSEHLDRS ASSOC PHONE: 2261 OLD GARDINER RD SEQUIM WA 983828718 SUBDIVISION: Block: Lot: + PARCEL NUMBER: 002353002 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 MOUNTPI983O6 Expires 9/26/2010 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI' SWAP OUT 120 GAL PROP TANK - SAME SIZE & LOCATION 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: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: 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 $71.00 LYK 09/23/09 1'10946 Total: $71.00 t-4iin44016-14 c6, JEFFERSON C�NTY • DEPARTMENT OF COMMUNITY DEVELOPMENT \ "3 ''4 621 Sheridan Street • Port Townsend •Washington 98368 nit � 360/379-4450 • 360/379-4451 Fax p www.co.jefferson.wa.us/commdevelopment tt MG Master Permit Application MLA: N, , ()IA 2 'i Project Description(include separate sheets as necessary): REP11 c4f .X/cTbil P& t T4/11" L )/J�7V I'l/>Ea) 74494. Tax Parcel Number: 002 353 00 Z- Property Size: /7,9 E$ (acres/square feet) Site Address and/or Directions to Property: itE /D6, Cf 538Z 1)I5C01 EA- 14 RI/ Rb5DA T Zzlp/ OLD D 674R,ONE,e 4.i) Will u if Property Owner(s)of Record: Z. /✓a C. 1)1 O. jam) Telephone:L/3✓4/9 -S/ 1'L/ice." Fax: email: 51-dCe76/4DA / ' i< Mailing Address: f'OI3 S, /vE 4/47 . 1>,2ti 5J 6-iD/21 , uT $z/79 Applicant/Agent(if different from owner): A✓/,¢ Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies 0 Lot or Road Segregation ❑Building ❑ Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family ❑ Garage Attached/Detached El Conditional Use[C(a), C(d),or C]** ❑ Manufactured Home .❑ Modular El Discretionary"D"or Unnamed Use Classification ❑ Commercial* ❑Special Use(Essential Public Facilities)** ❑ Change of Use 0 Boundary Line Adjustment ❑ Address ❑ Road Approach_ ❑ Short Plat** QUI j-lome Business ❑ Cottage Industry ❑ Binding Site Plan** Propane ❑ Long Plat** ❑ Sign - ❑ Planned Rurai Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis ❑ Plat Vacation/Alteration** ❑ Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions** ❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development** ❑Temporary Use ❑Shoreline Management Variance ❑Wireless Telecommunication* ❑ Comprehensive Plan/UDC/Land Use District Map Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment *May require a Pre-Application Conference El Tree Vegetation Request **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 to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: By signing this application form,the owner/agent 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 ent to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any require later inspections. Stairs a s £*right of entry will be assumed unless the applicant informs the County in writing at the time of the appli or she )ants Xior Signature: 7 • Date: /i� The action or actions Applicant will undertake gas a result of the issuance of this permit may negatively impact u on 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. y individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if you.are in m liance with t ffers n County development code.The Applicant acknowledges that he,she or it holds individual and non-trans le r s n . ility f adh to cirri-plying with the ESA. The Applicant has read this disc timer and signs an d es it below. Signature: , Date: G:\PemvtCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc • • 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 assu g the responsibilit f the G I Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: / 2/,yT1/6/ P/OP,i4 (560 6 i-/BF!/ (.3c.i9 35.-6 9/ff MAILING ADDRESS: Z4Q L�.� edfrili eat; EMAIL: /n/b C #' ,////TA//✓PP/,ff4E iJ CONTRACTOR'S LICENSE M 4.T , te..)g�33q WAINS NUMBER: 9JNUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: ❑ Sewer ❑ Addition 0 Steel Proposed: Bank I] Community System ❑ Alteration/Remodel 0 Concrete Total: _ Height: ❑ Individual System ❑ Repair 0 Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Pl r PaPRIE Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: V4 fL Proposed: 0 Public Total: Name of System: If this is a Commercial Projectyou 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: Underground Tank Above ground Tan Size of Propane Tank: J20 &/1 L Heat Stove Cook Stove 1 Woodstove Fireplace Insert Hot Water Tank Pellet Stove Other Is this appliance being installed in a Manufactured/Mobile Home? Yes / No fl9RK YhODEL 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: 2'1 Floor Heated Consistency Review: Other Heated Base fee: Mezzanine Additional Section: 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: $ 1 Receipt Number: I IOC) Cash/Check Number: ESTIMATED COST(REQUIRED) Date: (�- �y •Fair market value of all labor and materials foundation to finish T I t Initials: �L- ` .------ G:\PemutCenter\###FORMS###\DRD FORMS\Current ORD Forms\Master Permit Application 5-29-08.doc O 2 m C) -i z m -� 1 c) rn N 0 -1 74 oS ! t—, • r I � C' I 10 • � 1 -=I r U� r � rn v r O 7 z' m v v cn cn Qo -o 0 z rn z c CO m 0 -n -o m cn 0 z -o a • m -o �7 N Z o CD