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Home My WebLink AboutBLD2010-00346 • • 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 #: BLD10-00346 Received Date 9/29/2010 SITE ADDRESS: 1253 DEER CREEK RD Issue Date 9/29/2010 QUILCENE, 98376 APPLICANT: SEIICHI ADACHI TRUSTEE PHONE 206-824-3734 YOKO ADACHI TRUSTEE 19223 34TH AVE S SEATAC WA 981885313 1 SUBDIVISION: Block: Lot: PARCEL NUMBER: 601032020 Section: 3 Township: 26N Range: 01W CONTRACTOR: WASHINGTON ENERGY SERVICES CO PHONE: 206-282-4700 2800 THORNDYKE AVE W SEATTLE WA 98199 Contractor's License WASHIES971OB Expires 9/2/2011 OWNER, SEIICHI ADACHI TRUSTEE PHONE: 206-824-3734 if different: YOKO ADACHI TRUSTEE 19223 34TH AVE S SEATAC WA 981885313 PROJECT DESCRIPTION: REPLACE GAS TANKLESS HOT WATER HEATER 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 9/29/2011. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: / 0- 4 -t 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 11UILDING PERMIT APPLICA•N BL view Type: Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD10-00346 Received Date: 9/29/2010 SITE ADDRESS: 1253 DEER CREEK RD QUILCENE, 98376 OWNER: SEIICHI ADACHI TRUSTEE PHONE: 206-824-3734 YOKO ADACHI TRUSTEE 19223 34TH AVE S SEATAC WA 981885313 SUBDIVISION: Block: Lot: 1 PARCEL NUMBER: 601032020 Section: 3 Township: 26 N Range: 01 W CONTRACTOR: WASHINGTON ENERGY SERVICES CO PHONE: 206-282-4700 2800 THORNDYKE AVE W SEATTLE WA 98199 Contractor's License WASHIES971OB Expires 9/2/2011 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP REPLACE GAS TANKLESS HOT WATER HEATER TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC VALUATION MAIN: CODE EDITION: 2009 ADD'L: HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: CONST TYPE: OTHER: GARAGE: SHORELINE: CONST TYPE: 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 Permit $71.00 LYK 09/29/10 120143 Total: $71.00 g0N �o 4 iJEFFERSON COUNTY III . a A DEPARTMENT OF COMMUNITY DEVELOPMENT '' '� 621 Sheridan Street• Port Townsend • Washington 98368 360/379-4450• 360/379-4451 Fax �.qs NG zp www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: 1100 fl 1U k 1 Project Description(include separate sheets as necessary):REPLACE GAS TANKLESS HOT WATER HEATER Tax Parcel 601032020 Property Number: Size: (acres/square feet) Site Address and/or Directions to Property: 1253 DEER CREEK RD Property Owner(s)of Record: DERREK ADACHI Telephone:206-972-4479 Fax: email: Mailing Address: 19223 34TH AVE S,SEATAC 98188 Applicant/Agent(if different from owner): NORTHWEST PERMIT INC-CYNDAL OR NAIDA Telephone:360-945.2787 Fax: 360-948-2091 email: CmcALtP1:WPEnMIT.COM.NAIOA(y`NWPE,MITCOM Mailing Address: 1345 GULF RD,POINT ROBERTS WA 98281 What kind of Permit?(Check each box that applies OBuilding ❑Variance(Minor,Major or Reasonable Economic Use) ❑ Demolition Permit ❑Conditional Use[C(a),C(d),or C]** 2I Single Family ❑Garage Attached/Detached ❑Discretionary'D"or Unnamed Use Classification ❑ Manufactured Home ❑ Modular ❑Special Use(Essential Public Facilities)** ❑ Commercial• ❑Boundary Line Adjustment ❑ Change of Use ❑Short Plat** ❑ Address ❑Road Approach ❑Binding Site Plan** ❑Home Business ❑Cottagelndustry 0 Long Plat** ❑Propane ❑Planned Rural Residential Development(PRRD)/Amendments** ❑Sign ❑Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis ❑Shoreline Master Program Exemption/Permit Revisions** ❑Stormwater Management ❑Shoreline Management Substantial Development** ❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Variance Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment Forest Practices Act/Release of Six-Year Moratorium ❑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: 1, - % ,: .,/; DESIGNATION OF AGENT I hereby designate O12.f` { t7avtta. 4 - to act as my agent in matters relating to this application for permit(s). • OWNER SIGNATURE V JJ. f)0 C IAA} Date: ! 1 S-12.7 i t Sy 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 it's Knowledge. Any material falsehood or any omission of a material fact made by the ownerlagent 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' ctions. Stairs-access and right of entry will be assumed unless the applicant info c1rzi Cou/ jo writing at the time of the appli ion t or sh riot lice.nature: Date: l _ The action or actions Appicant will and ake 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 code.The Applicant acknowledges that he,she or it holds individual and non-transfgt able ry,�+ponsibir r adhering to mplying with the ESA. The Applicant has read this dis >merynd yigns an da s it bel w. Signature / / t � Date: • G/J ��0 CADocuments and Settings\ca:al\Local Settingn\Temporary Internet Files\OLK86\Master Permit Application 12-19-2006.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 as,gumin the esponsi 'Ay of the General Contractor for the proposed proojj�ect. Signature: ,, / � Date: / ;/ "A 1 zc.'/2 GENERALZ.ONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAx: WASHINGTON ENERGY SERVICES ( 800)398-4663 ( ) MAILING ADDRESS: CYNDAL@NWPERMIT.COM EMAIL: CYNDAL@NWPERMIT.COM CONTRACTOR'S LICENSE WAINS NUMBER: WASHIES971OB 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 Masonry SEP Permit# Demolition Other: Bedrooms: Water Supply: Existing: Setback: Private well ' Two Party Type of Heat: Proposed: Public GAS Total. Name of System: If this is a Commercial Proiect 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: ❑Underground Tank 0 Above ground Tank Size of Propane Tank: ❑Heat Stove 0 Cook Stove 0 Woodstove Q Fireplace Insert m Hot Water Tank 0 Pellet Stove 0 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 Bid App Review: 2na 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: $ el ( - Receipt Number: C Zo t t `3 Cash/Check Number: �c��t'^ ESTIMATED COST(REQUIRED) Date: CL-2q=q:2)_____ VJ•Fair market value of all labor and materials foundation to finish Initials: ---:-Th C:\Documents and Settings\caral\Local Settings\Temporary Internet Files\0LK86\Master Permit Application 12-19-2006.doc