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Home My WebLink AboutBLD2011-00237 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 #: BLD11-00237 Received Date 8/22/2011 SITE ADDRESS: 44 LEIGHBROOK LN Issue Date 8/22/2011 PORT LUDLOW, 98365 APPLICANT: SHIRLEY DAVIES-OWENS PHONE: 360-437-9820 WALTER DAVIES-OWENS 44 LEIGHBROOK LN PORT LUDLOW WA 98365-8745 22 SUBDIVISION: TIMBERTON VILLAGE PHASE I Block: Lot: PARCEL NUMBER: 998500022 Section: 17 Township: 28N Range: 01 E CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 1 R4M19 5875 OWNER, SHIRLEY DAVIES-OWENS PHONE: 360-437-9820 if different: WALTER DAVIES-OWENS 44 LEIGHBROOK LN PORT LUDLOW WA 98365-8745 PROJECT DESCRIPTION: GAS FIREPLACE REPLACEMENT 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 8/22/2012. REQUIRED INSPECTIONS: Tank/Line/Appliance: /C./ - S ` / r FinalApproval: ?�/7' / Z 105 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 •UILDING PERMIT APPLICA•N B 0237 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD11-00237 Received Date: 8/22/2011 SITE ADDRESS: 44 LEIGHBROOK LN PORT LUDLOW, 98365 OWNER: SHIRLEY DAVIES-OWENS PHONE: 360-437-9820 WALTER DAVIES-OWENS 44 LEIGHBROOK LN PORT LUDLOW WA 98365-8745 TIMBERTON VILLAGE PHASE I SUBDIVISION: Block: Lot: 22 PARCEL NUMBER: 998500022 Section: 17 Township: 28 N Range: 01 E CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2012 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP GAS FIREPLACE REPLACEMENT 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: 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 Bv: Date: Receipt: Approved/Date Propane Tanks/Stoves $71.00 LYK 08/22/11 128046 Total: $71.00 • • 4,9piiiii* L5—°N JEFFERSONLINTY \ DEPARTMENT OF COMMUNITY DEVELOPMENT o 621 Sheridan Street• Port Townsend•Washington 98368 360/379-4450 • 360/379-4451 Fax p'4 www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: . b (�I� r seal f d Project Description(include separate sheets as necessary): �r . . ,�" ‘ e. fl.z-t�) r/J "1 r-w ry) /1-6(i-C--Gc-y �. , i sip_ ) 'c Tax Parcel Number: q 41cs .5�J c, 6�22-2--Property Size: ` fee (acres/square feet Site Address 7/Or Directions to Property: 1-ji X,e,e ,17 rc,cve-- 1---1--) - Property Owner(s)of Record; «- -,— u.� /�cz,-.—c:.a� �J,j ��ir. zztse,e;-.3--`_Q: CEOVE --) Telephone: /3 1` > Fax: en54i;11 - ,i tOr Mailing Address: aetm-1z:._. c- — '-' AUG 2 1 Applicant/Agent(if different from owner) `d am-,<) ,,, ,____ , Pri..--fy --� Telephone: 385 ,s7 7 Fax: i 8 s -,�S 75 email: ' A '" ''' &J c- ,,� Mailing Address: /p d'.53 i�/1 c / SOP• ' Pi . //R-1-o c/ k)A trt_rl �F t um UNilY utvtlU}1 Th l What kind of Permit?(Check each•box that applies 0 Lot or F''coad Segregation OBullding 0 Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family ❑ Garage Attached/Detached 0 Conditional Use[C(a),:C(d),or C]** ❑ Manufactured Home 0 Modular • • 0 Discretionary"D"or Unnamed Use Classification O Commercial* 0 Special Use(Essential Public Facilities)** ❑ Change of Use 0 Boundary Line Adjustment Address 0 Road Approach 0 Short plat** ❑ Home Business 0 Cottage'Industry 0 Binding Site Plan** ,Fropane 0 Long Plat** ❑ Sign. ❑Planned Rural Residential Development(PRRD)/Amendments** ' ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** ❑ Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions** 0 Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development** 0 Temporary Use 0 Shoreli{ne Management Variance 0 Wireless Telecommunication* 0 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 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 j � t act as my agent in matters relating to "s application for permit(s). 1 0 •WNER SIGNATURE ��'��"_ `� � 4,*.e4/1� Date: / .°I // t 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 attorneys 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 inwectiefis, s access and right of entry will be assumed unless the applicant informs:th County in writing at the time of the applicat' �f�e:or ht r notice, r -'•nature: i�: YhJ �1�/ // 1 Date: The action or actions Applicant will undertake as a result of the issuance of this permit!may negatively impact upon one r 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 pie the Jefferson County development code:The Applicant acknowledges that he,she or it holds individual and non-transfer bI onsibility • Ti'_ •ng to and complying•with the ESA. The Applicant has'read this disclaim .an sin q dates it below. Signature: i,�� ''t ' Date: . 7 ' I lIITTI (-:•\Prrmrf'w,.,\#ttiRonMS###\r)Rn F(IRM.C\r, -n,, T1RT1 F.,,,.,,•\74,,,ro.P......:r A....I:,..,.:....c on no a.,,, 7/ L' i • • BUILDER STATEMENT The signer of this statement does ereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assuming the responsi ility of the General Contractor for the proposed project. Signature: Date:, . GENERAL CONTRACTOR O. tiR@b I-iC {htSCAtiER: PHONE: FAX: Sir,-, s 1+l n e tio 10A-v (26d ) 3 Fs- X 7 7 7 (3 Ge) 3 S-,.5 P 7-5- MAILING ADDRESS: /o r 5 3 Q-i,z,44.1_ pr P. (-( EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: S ILA II S > (;l'qq 7 Q N NUMBER ARCHITECT/ENGINEER: ` PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: 0 New 0 Wood Existing: ❑ Sewer 0 Addition 0 Steel Proposed: Bank 0 Community System 0 Alteration/Remodel 0 Concrete Total: Height: 0 Individual System ❑ Repair 0 Masonry SEP Permit# 0 ,Demolition ❑ Other Bedrooms: Water Supply: Existing: Setback: p Private well ❑ Two Party Type.of•Heat: Proposed: Total: ❑ Public Name of System:. • If this is a Commercial Project you must answer the following: Number of Parking Spaces: C rrent: Proposed: Number of ADA Parking Spaces: Number of occupants(includes wners,tenants;employees,etc) Current Proposed 4IBC Occupancy: IBC Type of construction: • Will you have Foot!S2rMice? Yes / No ' -1f this is a Propane Tank and/ r Appliance nation permi mark ail items below that apply: I Underground Tank I Above ground Tank Z -- cc_ of Propane Tank: TX/J i 1/09 /ei•r - £/°c, i Heat Stove I Cook Stove I Woodstove 1 Fireplace l) I Hot Water Tank I:Pellet Stove I Other Is this appliance being installed in a Manu re 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 &:, f k/ at ,,T•.;A +". Main Floor Heated ,y,:",�4 EH Bid App Review: p `� r` Consistency Review 2 Floor Heated a x - Other Heated 1, 'Jr,:-..o ,1 Base fee: 7Mezzanine 4,, '•.1' � �_%4 Additional:Section: k GgN,�Y ,,7, °gip. 4 µ Heated Basement , Y;5;5w a Plan Check fee: n {1 4t' ,,p ,� " e„a s t, Unheated Basement � x. r State Surcharge fee: '' ,= r ,X Other Unheated ' ` ; + Pot Water Review fee: Garage/Carport +6�rx ' SUBTOTAL Decks 0,:, 911/Rd Approach fee: Other " TOTAL: $ ' 71 - 14',;i0i.e4 122o`fio Receipt Number: w Cash/Check Number: 7 "' r 1' ESTIMATED COST(REQUIRED) Date: , 'Fair market value of all labor and materials foundation to finish Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forns\Master Permit Application 5-29-08.doc