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Home My WebLink AboutBLD2011-00186 • • 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 #: BLD11-00i Received Date 7/7/2011 SITE ADDRESS: 24 SPOTTED OWL LN Issue Date 7/7/2011 BRINNON, 98320 APPLICANT: TED M WILLIAMS PHONE: 206-251-5404 RENEE R WILLIAMS 22707 88TH AVE W EDMONDS WA 98026-8233 4 SUBDIVISION: BOLING SHORT PLAT Block: Lot: PARCEL NUMBER: 502151036 Section: 15 Township: 25N Range: 02W CONTRACTOR: COMFORT HEATING & COOLING PHONE: 360-402-2054 121 CEDAR ST SHELTON WA 98584 Contractor's License COMFOHC900KE Expires 5/5/2012 OWNER, TED M WILLIAMS PHONE: 206-251-5404 if different: RENEE R WILLIAMS 22707 88TH AVE W EDMONDS WA 98026-8233 PROJECT DESCRIPTION: NEW DUCTLESS HEAT PUMP 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 7/7/2012. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: 7/)0 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 BLD11-000179 tILDING PERMIT APPLICATI N Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD11-00 f St~, Received Date: 7/7/2011 SITE ADDRESS: 24 SPOTTED OWL LN BRINNON, 98320 OWNER: TED M WILLIAMS PHONE: 206-251-5404 RENEE R WILLIAMS 22707 88TH AVE W EDMONDS WA 98026-8233 BOLING SHORT PLAT SUBDIVISION: Block: Lot: 4 PARCEL NUMBER: 502151036 Section: 15 Township: 25 N Range: 02 W CONTRACTOR: COMFORT HEATING & COOLING PHONE: 360-402-2054 121 CEDAR ST SHELTON WA 98584 Contractor's License COMFOHC900KE Expires 5/5/2012 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI` NEW DUCTLESS HEAT PUMP 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: 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 Permit $97.25 LYK 07/07/11 123687 Plan Check $63.21 LYK 07/07/11 123687 State Building Code $4.50 LYK 07/07/11 123687 Total: $164.96 N , L, JEFFERSC UNTY `� DE4ir PARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend •Washington 98368 • $ 360/379-4450 • 360/379-4451 Fax ��p www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: 00 (YL?AV)) Project Description Include rate shee sSnecessary)) ,/� - /-- Al c7��,e rate c'7�-� — /T Q.--/ 1t't— Tax Parcel Number: SO ,'! f 5 7 0,3i Property Size: / ,4G,¢ (acres/square feet) Site Address and/or Directiosp to Property: ,211 flelo#'G./acit. L..-4-we /3/z.m/N er , w4- 7Pj' , Sa-tetz 4 ../-, K .rt f « Pr., -4 L As O .fie d.4-£ ✓-9 L el P u►ex,_b Property Owner(s)of Record: / EP • w/LG (4--$1 S 1 , Telephone: 2 ' ' - 2-S'( -S'4/c, V Fax:jV.4 email: 7=Al RhLL(�n+E3F/lo.�4d" c ,,01f Mailing Address: 107 Rrki A-ve u/• GAD M a /J)j m./,4 J e,2-6 Applicant/Agent(if different from owner): /t/i9- Telephone: J✓4 Fax: email: Mailing Address: ///A- What kind of Permit? heck each box th applies Building rA iteit 0 Critical Areas Stewardship Plan ElDemol'ion Permit �J 0 Variance(Minor,Major or Reasonable Economic Use) 0 Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a),C(d),or C]" O Manufactured Home 0 Modular 0 Discretionary"D"or Upper ❑ Commercial* 0 Special Usef(Esseratral fP MOW ❑ Change of Use 0 Boundary Line U- ❑ Address 0 Road Approach 0 Short Plat" ❑Home Business 0 Cottage Industry 0 Binding Site Plea( t ❑Propane 0 Long Plat"" i r\\ I nit 7 "1,1 ❑Sign 0 Planned Rur 11ltesidential Development(PRRD is"* ❑Allowed'Yes'Use Consistency Analysis 0 Plat Vacation'Alteration ❑Stormwater Management 0 Shoreline Master Program ,• - . -�r -evisions" O Site Plan Approval Advance Determination(SPAAD)" 0 Shoreline Management Subs iial• �it •i " ❑Temporary Use 0 Shoreline Ma Y DEV ' ❑Wireless Telecommunication" 0 Comprehensive"Pran�I C/L District Map Amendment ❑Forest Practices Act/Release of Six-Year Moratorium 0 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: • wA �, _cf-. 6,,,,iL-4c.,,, R.e,Z,k(t (. -6 4.€4-a`' O dl'.yN4211) DESIGNATION OF AGENT C I hereby designate NA' to act as my agent in matters relatingto this application for PPI� 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 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 inform the County in writing at the time of the applica at qr she wants ' notice. Signature: al It/ Date: The action or actions Applicant 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 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-transferal po srbiGty for adhering to a cogrpying with the ESA. The Applicant has read this discla.3/ / nd}(gns and dates it below. Signature: C � ? ty- Date: l/ G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc BUILDER STATEMENT 4111 • 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.7/ Signature: 1 �, (/� Date: G// / GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE:!! FAX: Cv1') �r 2 �2A-�/N G Coo Gl•v is (3(pa 2o&/ .�" (/-Q) �,/ MAILING ADDRESS: l Z( F Ged Se t�T EMAIL:Ca,.=ffl/Q,r/tQ ikC C In4I L-C CONTRACTOR'S LICENSE 3-it L -sr• iv g,��'y WAINS NUMBER: r Om G tD �G 9 u, O /� E NUMBER ARCHITECT/ENGINEER: T / PHONE ( ) FAX:( ) MAILING ADDRESS: " '" '- EMAIL Project Type: N4 Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank 0 Community System ❑ Alteration/Remodel 0 Concrete Total: _ Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition 0 Other. Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: 0 Public Total: Name of System: If this is a Commercial Protect you must answer the following: A/4 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: A/4. I Underground Tank I Above ground Tank Size of Propane Tank: I Heat Stove 1 Cook Stove I Woodstove I Fireplace Insert I Hot Water T k i Pellet Stove I 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 • 4a..� r ;. I/ •roperty lines,tank location and size,distances from the propane tank to all property lines,build*,3,-7 a. ir,,lii�-- . ents, includin• the reserve area. -- s'— i ` T�� d _ z S•uare Fobtb e' Current ' ••. : W °x.. .. Main Floor Heated - *rqz EH Bid App Review. 2n0 Floor Heated l: � Consistency R i i I . 0c •+ JEFFERSON rnIINTY Other Heated nr, . -tu. Base Dqq/O IT DFVILOPMFNT Mezzanine " Additional Section: 11 r Heated Basement t� Plan Check fee: Unheated Basement # , aState Surcharge fee: Other Unheated so $ Pot Water Review fee: • Garage/Carport SUBTOTAL Decks -r- 911/Rd Approach fee: ..Other 1. //,�,� � — . y w "` 0._ z TOTAL: $ !4 q.% se�� Pw � . Receipt Number 3167,, Y 1 " ` Cash/Check Number: et, ESTIMATED COST(REQUIRED) Date: I .Fair market value al all labor and materials foundation to finish 3 , 30 Initials: • G:\PcrmitCentcr\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc • • C �Q � o PtA7f' ; UL 7 i1 / JEFFERSON COUNTY _.�--- /4 AA g- _ DEPT. F COMMUNITY DEVELOPMENT II "--/-A-r21 y 5,0 ire/ o w L C., /.e- -r 20‘ ?-57 5 V°V