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Home My WebLink AboutBLD2012-00297 • • 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 #: BLD12-00297 Received Date 9/26/2012 SITE ADDRESS: 3161 S DISCOVERY RD Issue Date 9/26/2012 PORT TOWNSEND, 98368 APPLICANT: TOD A EASTON PHONE: 360-301-3650 JANICE M KEMP JTWROS 3161 S DISCOVERY RD PORT TOWNSEND WA 98368-9011 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001293003 Section: 29 Township: 30N Range: 01W CONTRACTOR: EVERWARM INC PHONE: (360) 452-3366 257151 HWY 101 PORT ANGELES WA 98362 Contractor's License EVERWI*088NL Expires 9/17/2014 OWNER, TOD A EASTON PHONE: 360-301-3650 if different: JANICE M KEMP JTWROS 3161 S DISCOVERY RD PORT TOWNSEND WA 98368-9011 PROJECT DESCRIPTION: NEW WOODSTOVE 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 9/26/2013. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: I I I- I 77 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 \\tidemark\data\forms\F_BLD_Permit_Propane.rpt 9/26/2012 ItUILDING PERMIT APPLICA ION B Review 0297 Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD12-00297 Received Date: 9/26/2012 SITE ADDRESS: 3161 S DISCOVERY RD PORT TOWNSEND, 98368 OWNER: TOD A EASTON PHONE: 360-301-3650 JANICE M KEMP JTWROS 3161 S DISCOVERY RD PORT TOWNSEND WA 98368-9011 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001293003 Section: 29 Township: 30 N Range: 01 W CONTRACTOR: EVERWARM INC PHONE: (360) 452-3366 257151 HWY 101 PORT ANGELES WA 98362 Contractor's License EVERWI*088NL Expires 9/17/2014 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION NEW WOODSTOVE 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: ppred/Date Propane Tanks/Stoves $148.00 LYK 09/26/12 135242 44.0P V L. Total: $148.00 SEP2' "2 Jefferson County Plannint & Building Department \\firlomorL\rlofo\fnrmc\C RI fl sr•n PIA rnf O/0g/0(11 0 • , ,gON c06,, JEFFERSON'UNTY h `ram DEPARTMENT OF COMMUNITY DEVELOPMENT '4 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax �q O� www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: no 1,.\()L4 Project Description(include separate sheets as necessary): WcIoi) 5 To ✓.= (N3Sc27 Tax Parcel Number: c c 'i 2`j 3 �1(, 3 Property Size: ' .t'j A . (acres/square feet) Site Address and/or Directions to Property: Property Owner(s)of Record: .Too l=its.c-a../ / -c-34-Ki tL i N.A p Telephone: A:,(` 36 k 3 L- S_0 Fax: email:-7=,,-/EiL S 1-c-A(4' ,,(i k c.: . . :..-.._ Mailing Address: .5iL t 5', 0.5 ' ....#..y iZ0 kw a_!, -To.,;.., -',..i I) Lt..•A `ii' 3C Applicant/Agent(if different from owner): Telephone: Fax: email: _ Mailing Address: gat kind of Permit? (Check each box that applies 0 Lot or Road Segregation wilding 0 Critical Areas Stewardship Plan 0 Demolition Permit 0 Variance(Minim ❑ Single Family 0 Garage Attached/Detached 0 Conditional Use , - , r E --T ❑ Manufactured Home .0 Modular 0 Discretionary"D"a r o Commercial* 0 Special Use(Esse tjal Public Facilities)** ❑ Change of Use 0 Boundary Line Adjustment 0 Address 0 Road Approach 0 Short Plat** ' ') 0 '912 ❑ Home Business 0 Cottage Industry 0 Binding Site Plan** ❑ Propane 0 Long Plat** " i—) ❑ Sign 0 Planned Rural Residentiaj (PRRD)/Am aments** ❑Allowed"Yes" Use Consistency Analysis 0 Plat Vacation/Alteration r cc.,^v!,Nrn Dp'rl r)orArr,Ir ❑ Stormwater Management ❑ Shoreline Master ProgTarn Exemp io a ns** ❑Site Plan Approval Advance Determination (SPAAD)* 0 Shoreline Management Substantial Development** Temporary Use 0 Shoreline Management Variance ❑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 to act as my agent in matters relating to this application for 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 informs the County in writing at the time of the a5Iglicatiorrtfi-' or he / Date: nts_prior notice. Signature` _ ✓� . / ._2 e. - / 2_ -•The action or actions Applicant will undertake as a 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-transferab i flit or adheri complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. ignat . �- Date: 2 .2 --Z.---. (_•\D,,..„;«('o.,«p.\\fftftfF(1R\fCfftftf\FIR rl F(1R mg\('...—«TIRTI F,-,- \1\f.,,«o.Da.„.:« 4....1:,....;,.„c In 114,7,.,. ! • 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 t re onsibility of the General Contractor for the proposed project. - � Date: ,j �' I Z. Signature: � -- GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PFIONE: FAX: E J 12 Li A( tIv\ k.- rEAA.tLT lk s jr\o.A,..� (360 4'5-Z - 3 34,6 (3w) 'Is-2 - 3 3 i<'7 MAILING ADDRESS: 2 5-7 I j 1 \{W Y U CAST EMAIL.: t` fir~' yt/:tf,„ U L • �: vl . c_r \N\ CONTRACTOR'S LICENSE WAINS NUMBER: L V 1 L rZ\1/4,' v 8i.'t t.1 1..._ an) 9/I 7/l pUMBER ARCHITECT/ENGINEER: / PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: r_; New ❑ Wood Existing: G Sewer ❑ Addition r, Steel Proposed: Bank C Community System C Alteration/Remodel ❑ Concrete Total: _ Height: ❑ Individual System ❑ Repair 0 Masonry SEP Permit# _ ✓ Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well 0 Two Party Type of Heat: Proposed: 0 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 i3C 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: 1 Underground Tank 1 Above ground Tank Size of Propane Tank: i Heat Stove i Cook Stove 1 Woodstove 0"Fireplace Insert:1 Hot Water Tank 1 Pellet Stove i Other Is this appliance being installed in a Manufactured/Mobile Home? Yes KNo . 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 a!!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: 21'd Floor Heated Consistency Review: Other Heated Base fee: Lt53 / Mezzanine Additional Section: 1 Heated Basement Plan Check fee: .\ Unheated Basement State Surcharge fee: • Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: L Other TOTAL: $ It) i Receipt Number: Cash/Check Number: ESTIMATED COST(REQUIRED) Date: •Fair market value of all labor and materials foundation to finish 4 ,�(,c'e:?-7, %G Initials: G.\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc