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Home My WebLink AboutBLD2012-00165 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 #: BLD12-00165 Received Date 5/29/2012 SITE ADDRESS: 340 TALA SHORE DR Issue Date 5/29/2012 PORT LUDLOW, 98365 APPLICANT: JOSEPH W MC KEE TRUSTEE PHONE: 206-780-7780 LESCA MC KEE TRUSTEE 5771 RAVENSWOOD CT BAINBRIDGE ISLAND WA 98110-3635 5 SUBDIVISION: TALA SHORES #3 Block: Lot: PARCEL NUMBER: 998200305 Section: 15 Township: 28N Range: 01E CONTRACTOR: FAST WATER HEATER COMPANY PHONE: 425-636-7054 12601 132ND AVE NE KIRKLAND WA 98034 Contractor's License FASTWWH948BC Expires 1/4/2014 OWNER, JOSEPH W MC KEE TRUSTEE PHONE: 206-780-7780 if different: LESCA MC KEE TRUSTEE 5771 RAVENSWOOD CT BAINBRIDGE ISLAND WA 98110-3635 PROJECT DESCRIPTION: REPLACE ELECTRIC 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 5/29/2013. REQUIRED INSPECTIONS: Tank/Line/Appliance: 7.) 12J J 2- " ri- FinalApproval: 2.'�2, F—P BUILDING INSPECTION HOT-LINE 379-4455. Request must be received by 7am the day the inspection is needed Office Hours 9:00 a.m. -4:30 p.m. MONDAY- THURSDAY HOT LINE AVAILABLE 24 HOURS A DAY I:\F_BLD_Perm it_P ropa ne.rpt 10/29/19 fitILDING PERMIT APPLICATt BLD12-00165 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD12-00165 Received Date: 5/29/2012 SITE ADDRESS: 340 TALA SHORE DR PORT LUDLOW, 98365 OWNER: JOSEPH W MC KEE TRUSTEE PHONE: 206-780-7780 LESCA MC KEE TRUSTEE 5771 RAVENSWOOD CT BAINBRIDGE ISLAND WA 98110-3635 TALA SHORES#3 SUBDIVISION: Block: Lot: 5 PARCEL NUMBER: 998200305 Section: 15 Township: 28 N Range: 01 E CONTRACTOR: FAST WATER HEATER COMPANY PHONE: 425-636-7054 12601 132ND AVE NE KIRKLAND WA 98034 Contractor's License FASTWWH948BC Expires 1/4/2014 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION REPLACE ELECTRIC WATER HEATER TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION 1,252.00 ADD'L: HEAT TYPE: CODE EDITION: 2009 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 Permit $47.90 LYK 05/29/12 131760 Plan Check $31.14 LYK 05/29/12 131760 State Building Code $4.50 LYK 05/29/12 131760 Total: $83.54 ! • 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: 66 \f eck-1 )L9?-10 703— 04-06i 103(67O?5 MAILING ADDRESS: \ )\ \39- 44 N 111 Ntit.I k EMAIL: U11e C�(�-G(S'hW \ Q- �' C.L rl R CONTRACTOS LICENSE 1 c� `,31� WAINS NUMBER: RSlt\sVi wA(4-05 C NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New I Wood Existing: ❑ Sewer ❑ Addition I I Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel a Concrete Total: Height: ❑ Individual System XRepair U Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: I I Private well fl 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 and/or Appliance Installation permit,mark all items below that apply: i Underground Tank i Above ground Tank Size of Propane Tank: Heat Stove i Cook Stove Woodstove i Fireplace Insert Hot Water Tank 1 Pellet Stove Other Is this appliance being installed in a Manufactured I Mobile Home? Yes I 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 Bld App Review: 2"0 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 1 n\n l rn `r Q TOTAL: $ q-3 Ft~eceipt Number: 1 —1(40t. ash/Check Number: .320 Li ESTIMATED COST(REQUIRED) Date: c _ .Fair market value of all labor and matertals,founaanan-lo fingsh Initials: • G:\PcrmiK:cnter\###FORMS###\DR)FORMS\Master Permit Application 5-29-08.doc c • II5i 09 1471,114 O JEFFERSON COUNTY i44104 `,A DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax �Kq��N ,SO'� www.co.jefferson.wa.us/commdevelopment 0 Master Permit Application MLA: (10 I l lciA Project Desc iption(include separ to sheets as necessary): Re�i1�v�� V��Iace Plec+( c v� a� Ineu- c. Tax Parcel Number:6141c-g a 0 0 3c J Property Size: (acres/square feet) Site Address and/or Directions to Property: '30 gala S11c�e., Di. Property Owners)of Record: S e i*. C e.. Telephone: '7 Fax: email: Mailing Address:3 -1— \a , lt,(Q •D ct Y'C �l'C , 0t\i",c\IJ A\ ci$3 to G Applicant/Agent(if different from owner): fay 0.. "C1 Telephone:435. lei 3(s• 70c' Fax: 3 . (A, email: e C @ Sj -(-e(- Mailing Address:I a�0k 13-R C,, �\ (AA I\ 3&4 0.`Pf.C C u V�\ What kind of Permit?(Check each box that applies Building ❑Critical Areas Stewardship Plan ❑ Demolition Permit 0 Variance(Minor,Major or Reasonable Economic Use) XSingle Family 0 Garage Attached/Detached 0 Conditional Use[C(a),C(d),or C]** ❑ Manufactured Home 0 Modular 0 Discretion ry--- F. ' ❑ Commercial* 0 Special Use( I u i c I i ❑ Change of Use 0 Boundary Line/1Id)n ❑ Address 0 Road Approach 0 Short Plat'* ❑Home Business 0 Cottage Industry 0 Binding Site Plan"* ❑Propane El Long Plat** MAY 2 9 20127:4 ❑Sign ❑Planned Rural Residential Development ndments** ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/A ration*" ,I ❑Stormwater Management 0 Shoreline Master Progr M =1 1 - ' Revisi ns ❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Managefamet u is 1 I ei pment** ❑Temporary Use El Shoreline Managemen-V ' i' OPI .NT 0 Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment 0 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 /� to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE 56C,l P (-(1\a 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 informs the County in writing at the time of the application that he or she wants prior notice. Signature: 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-transferable responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: Date: G:\PermitCenter\###FORMS###\DRD FORMS\Master I'crmit Application 5-29-08.doc