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Home My WebLink AboutBLD2011-00068 • III 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 #: BLD11-00068 Received Date 3/23/2011 SITE ADDRESS: 61 FLEET DR Issue Date 3/23/2011 PORT LUDLOW, 98365 APPLICANT: EVELYN S CASTILLO PHONE: C/O SASHA COFFEY 61 FLEET DR PORT LUDLOW WA 98365-9680 98 SUBDIVISION: PORT LUDLOW NO. 2 AREA 3 Block: Lot: PARCEL NUMBER: 990600398 Section: 8 Township: 28N Range: 01 E CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTPI983O6 Expires 9/26/2011 OWNER, EVELYN S CASTILLO PHONE: if different: C/O SASHA COFFEY 61 FLEET DR PORT LUDLOW WA 98365-9680 PROJECT DESCRIPTION: A/G 120 GAL PROP TANK, LINES & HEAT 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 3/23/2012. REQUIRED INSPECTIONS: 04,1( Tank/Line/Appliance: f /6T L-//jf i 41"1 i'L k -71 c, 1-1 eDe ,/ L MI5 FinalApproval: , 4-4 L 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 ilt1ILDING PERMIT APPLICA1N BLD11-00068 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD11-00068 Received Date: 3/23/2011 SITE ADDRESS: 61 FLEET DR PORT LUDLOW, 98365 OWNER: EVELYN S CASTILLO PHONE: C/O SASHA COFFEY 61 FLEET DR PORT LUDLOW WA 98365-9680 PORT LUDLOW NO. 2 AREA 3 SUBDIVISION: Block: Lot: 98 PARCEL NUMBER: 990600398 Section: 8 Township: 28 N Range: 01 E CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTPI983O6 Expires 9/26/2011 REPRESENTATIVE: SASHA COFFEY PHONE: 360-732-4585 61 FLEET DR PORT LUDLOW WA 98365 PROJECT DESCRIPTION A/G 120 GAL PROP TANK, LINES & HEAT STOVE TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION MAIN: CODE EDITION: 2009 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 Bv: Date: Receipt: Approved/Date Propane Tanks/Stoves $213.00 LYK 03/23/11 123323 Total: $213.00 , ,gffrivt JEFFERSOI RUNTY • 1�� cc, 4A DEPARTMENT OF COMMUNITY DEVELOPMENT 13. ` ''d 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax �<yS,�NaO$ www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: y) �1( A e e' I t Projectt Description(i ude s rate she is as necessary): 1 ' ('� (- (�S. Alp t.k k L i i i i-, (- l eC�l -•C� Tax Parcel Number. Ci)' ) Property Size: (acres/square feet) Site Address and/or Directions to Proper U-, ( 1 k i Property Owner(s)of Record: Telephone: �t� Fax: - 7i email�C�b�'4.•C.Cif U i v"K ( ( '— Mailing Address: 31 ;yf' i , L Applicant/Agent(if different from owner): S ` 'H Telephone: ' \._1i"\-t Fax: email: Mailing Address: 713 hat kind of Permit?(Check each box that applies wilding ❑Critical Areas Stewardship Plan ❑ Demolition Permit 0 Variance(Minor,Major or Reasonable Economic Use) ❑Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a),C(d),or Cj** ❑ Manufactured Home 0 Modular 0 Discretionary"D"or Unnamed Use Classification ❑ Commercial* 0 Special Use(Essential Public Facilities)** ❑ Change of Use ❑Boundary Line Adjustment ❑ Address 0 Road Approach 0 Short Plat'"` I Home Business ❑ Cottage Industry ❑Binding Site Plan** [(Propane ❑Long Plat** ❑Sign ❑Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration** ❑Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions** ❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development** ❑Temporary Use 0 Shoreline Management Variance ❑Wireless Telecommunication* ❑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 0 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 E to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE -")(A-4--1/4"\- C Date: 3 • 'l By signing this application form,the own nt 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 attomey'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 la - •- ions. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the xtime of the application that ': or s is prior notie.Signature: � c,),Apr Date: `3' 22- The action or actions Applicant wi .ke 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 i tarp fiance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual nd non-transferable res nsibili for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. fa ignature: C; o, Date: 3•2-2.•11 (;:\PerrnitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-O8.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 assuming the responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: MBMAILING ANESQ�201�> ►E, �I� K! C / ( ) ( ) EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX;( ) MAILING ADDRESS: ' EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: I Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel 0 Concrete Total: Height: ❑ Individual System ❑ Repair 0 Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: I 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: 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 anrllnr APOIiafGe ICrstalIation permit,mark all items below that apply: i Underground Tank Aboveve ground Tarik ` Size of Propane Tank: l7Q o I Heat Stove i Cook Stove j Woodstove i Fireplace Insert 1 Hot Water Tank f Pellet Stolle Other L 1 (J 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 , titii :•Only Amount ,, Qtayjsion Main Floor Heated EH BId App Review: 2f4 Floor Heated Consistency Review: Other Heated Base fee: 3 ,- 9 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: $ ' Receipt Number: i ! t Cash/Check Number: IlLESTIMATED COST(REQUIRED) Date: J *Fair market value of all labor and materials foundation to finish Initials: 1 L • G:\PctmitCcnter\###FORMS###\MUD FORMS\Master Permit Application 5-29-08.doc • • ? re; oiN /f ALM O v i a �ih d� `C ♦ .7� c.1-ea4 ems- sc i Z' t �\; \ka ‘v- v 6J f kaliOk_