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HomeMy WebLinkAboutBLD2009-00348 • 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 #: BLD09-00348 Received Date 10/12/2009 SITE ADDRESS: 9493 SR 20 Issue Date PORT TOWNSEND, 98368 10/12/2009 APPLICANT: SNOW BLIND LLC 9493 STATE ROUTE 20 PHONE: 360 301 2220 PORT TOWNSEND WA 98368-9361 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001162007 Section: 16 Township: 30N Range: 01W CONTRACTOR: OWNER/BUILDER PHONE OWNER, SNOW BLIND LLC PHONE: 360-301-2220 if different: 9493 STATE ROUTE 20 PORT TOWNSEND WA 98368-9361 PROJECT DESCRIPTION: A/G 1000 GAL PROP TANK SWAP OUT-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 10/12/2010. REQUIRED INSPECTIONS: Tank/Line/Appliance: f FinalApproval: t " D? 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 QUILDING PERMIT APPLICA•N BLD09-00348 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD09-00348 Received Date: 10/12/2009 SITE ADDRESS: 9493 SR 20 PORT TOWNSEND, 98368 OWNER: SNOW BLIND LLC PHONE: 360-301-2220 9493 STATE ROUTE 20 PORT TOWNSEND WA 98368-9361 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001162007 Section: 16 Township: 30 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr A/G 1000 GAL PROP TANK SWAP OUT - SAME SIZE & LOCATION TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2006 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: 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 Total: • T,- ---- - _.___________ , , , G-..,_ ,„..._______________________S- , ) -4 , -T\ lE ) , . , 1 t ; i c17\,, _ -?r, 4- ' )\ '1-' P...4. ' o4 ,c) i 1 I t� it CP' Zo ? I z-c 1 r ! `/�r z J-- ( D ( 1-- z ( ► OCT 12 : r3 \iii , 1 ovormk 44'.�011T COS JEFFERSO BOUNTYIII ` DEPARTMENT OF COMMUNITY DEVELOPMENT i' 621 Sheridan Street • Port Townsend •Washington 98368 ,� 360/379-4450 • 360/379-4451 Fax ��yS,�N�,sp www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: 00 Project Description(include separate sheets as necessary): f aR - Zvi IL Lock_ L S4-16 SI ZE Tax Parcel Number: C:�Q ( I (off A D�• �I is) �: � i , . . d 0 1 Property Size: J Site Address and/or Directions to Property: (acres/square feet) 9 Li?3 H W a © Rx,--� " TO(' s".ek,�-4? _ Property Owner(s)of Record: Ski p L,Z b i<i N Telephone: 360 -3O( -,2 b Fax.,j 73 -7 ", email:Mailing Address: VK Applicant/Agent(if different from owner): k.wt.f' Telephone: Scab,,. Fax: Mailing Address: email: What kind of Permit?(Check each box that applies 0 Lot or Road Segregation ❑Building ❑ Demolition Permit 0 Critical Areas Stewardship Plan ❑Single Family ❑ Garage Attached/Detached 0 Conditionalninor Use[C(a)rC(d)Reo C]able Economic Use) ❑ Manufactured Home .0 Modular 0 Discretionary"D"or Unnamed Use Classification ❑ Commercial* 0 Special Use(Essential Public Facilities)** ❑ Change of Use 0 Boundary Line Adjustment ❑ Address 0 Road Approach__ 0 Short Plat** ❑ Home Business ❑Cottage Industry 0 Binding Site Plan** XrPropane ❑Sign 0 Long Plat** 0 Planned Rural Residential Development(PRRD)/Amendments** ID Allowed"Yes"Use Consistency Analysis 0Plat Vacation/Alteration** ❑ Stormwater Management SPAAD 0 Shoreline Master Program Exemption/Permit Revisions** ❑ Site Plan Approval Advance Determination ❑Temporary Use ( ) 0 Shoreline Management Substantial Development** ❑Wireless Telecommunication* 0 Shoreline Management Variance ❑ Forest Practices Act/Re of Six-Year Moratorium 0 Comprehensive Plan/UDC/Land Use District Map Amendment *Mayrequire a Pre ❑JeffersTree eg County Shorelinequest Master Program Amendment e9 -Application Conference ❑Tree Vegetation Request **Requires a Pre-Applition Conference Please identify any other local,state or federal permits required for this proposal,if known: I hereby designate ��� J �, I l DESIGNATION OF AGENT to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE •...---,....0"-. Date: /U//oZIO`j' By signing this applicati orm e 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 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 he wants pr. notice. Signature: /�� .�' Io 1L Date: Q j The action or actionsZlicant 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 tederal 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 and non-transferable responsibility fo�in to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: cif ��//� Date: f- 210 — G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc BUILDER STATEMENT The signer of this statement does hereby certify that theyoare the teers of the proposed parcel j referenced erenced herein,that they are not licensed contractors and that they will be assuming the responsibility of the ner J Z Date: Signature: PHONE: Fes' GENERA ONT OR OR MANUFACTURED HOME INSTALLER: ( ) ( ) EMAIL: MAILING ADDRESS: WAINS CONTRACTORS LICENSE NUMBER NUMBER: PHONE ( ) Fes'( ) ARCHITECT/ENGINEER: EMAIL MAILING ADDRESS:Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:CI Wood Existing: ❑ Sewer ❑ New❑ Addition ❑ Steel Proposed: Bank ❑ Community System Total: _ Height: ❑ Individual System ❑ Alteration/Remodel ❑ Concrete SEP Permit# pa ❑ De CIO Bedrooms: Water Supply: • Demolition ❑ Other:her: Existing: Setback: ❑ 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 ADA Parking Spaces: Number of Parking Spaces: Current: Proposed: ed Propos Number of occupants(includes owners,tenants,employees,etc) Current Will you have Food Srvice? Yes / No IBC Occupancy: _ IBC Type of construction: If this is a Pro ane Tank and/or A liance Installation rmit mark all items below e that a I I Underground Tank ground Tank Size of Propane Tank: I Heat Stove i Cook Stove i Woodstove i Fireplace Insert I Hot Water Tank i Pellet Stove I Other !Itis appliance bein installed in a Manufactured/Mobile Home? Yes / No When applying for a permitd installtac a propanemthe tank you must also submit a site tank to all property lines,lan showing all of the buildings and septic buildings,all lines,tank location and size, distances frompropane includin• the reserve area. Amount Revision S•uare Foota•e Current Proposed For Office Use EHO IB App Review: Main Floor Heated Consistency Review: 2 ' Floor Heated Base fee: Other Heated iiiiiii Additional Section: 111111111111 Plan Check fee: Heated Basement State Surcharge fee: Unheated Basement .. — Pot Water Review fee: Other Unheated SUBTOTAL Garage/Carport Decks 911/Rd Approach fee: Other TOTAL: MOM IIIIIIIIIIIIIIIIIIIIII Receipt Number: I t 0 •Z IIIIIIIIIIIIIIIIIIII CashlCheck Number: cz ESTIMATED COST(REQUIRED) Date: . fit,. •Fair market value of all labor and materials foundation to finish Initials: NUMMI G:\PemutCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc