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Home My WebLink AboutBLD2012-00364 • • 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#: BLD12-00364 Received Date 11/8/2012 SITE ADDRESS: 2481 ANDERSON LAKE RD#121 Issue Date 11/8/2012 CHIMACUM, 98325 APPLICANT: JOHN HIXON PHONE: 281-638-1014 DONNA HIXON PO BOX 338 CHIMACUM WA 98325 SUBDIVISION: EVERGREEN COHO ESCAPEE RESORT Block: Lot: PARCEL NUMBER: 901101039 Section: 10 Township: 29N Range: 01W CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/7/2014 OWNER, JOHN HIXON PHONE: 281-638-1014 if different: DONNA HIXON PO BOX 338 CHIMACUM WA 98325 PROJECT DESCRIPTION: A/G 150 GAL PROP TANK& Imo` 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 11/8/2013. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: - _ lV i 1— `3 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_Propa ne.rpt 11/8/2012 SUILDING PERMIT APPLICA•N BLD12-00364 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD12-00364 Received Date: 11/8/2012 SITE ADDRESS: 2481 ANDERSON LAKE RD#121 CHIMACUM, 98325 OWNER: JOHN HIXON PHONE: 281-638-1014 DONNA HIXON PO BOX 338 CHIMACUM WA 98325 EVERGREEN COHO ESCAPEE RESORT SUBDIVISION: Block: Lot: PARCEL NUMBER: 901101039 Section: 10 Township: 29 N Range: 01 W CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/7/2014 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr A/G 150 GAL PROP TANK & LINES TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2009 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: 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 $148.00 LYK 11/08/12 135389 ; P P R` ,y 6 E Y Total: $148.00 NOV lu i2 ,:oltKzon County Plann n & Building Demartrncnt \\firlcrnnrk\rIn+e\fnrrr.c\C RI f1 Ann PIA rnf 11/Q/9l119 sON c0� JEFFERSONNTY • W ' .A DEPARTMENT OF COMMUNITY DEVELOPMENT I-) ` '4 621 Sheridan Street • Port Townsend •Washington 98368 lop360/379-4450 • 360/379-4451 Fax 0 www.co.jefferson.wa.us/commdevelopment /s.htING� i , , CE0 V � � Master Permit Application MLA: no �( Pr jet Description(inclu eparate sh ets as necessary): I 0 l. lGa l► '12 J)/ T x Parcel Nu ber: (`fit t(JI± 'Property Size: (acres/square feet) Site Address and/or Directions to Properly: JEFFERSON COUNTY 2L I 4=11yDGQ-50V1 1-44. DST.0j O' N17DEVELOPMENT S /�L Property Owner(s)of_Record: Dk4`1a Ar DO?l` L - xp1.) elephone: Fax: email: Mailing Address: 2-4-rg, t 'Ar?cD�1.SDTf L-i,._ f_12:$ ✓.t. �cJ)A 4z3 — Applicant/Agent(if different from owner): ,=-p po14o4 r4 t-}-^ X obi Telephone: Fax: email: _ Mailing Address:_ 1 eneteik_� 1,.V.,- jaJ 34—ap7 Gf},a,,Mp,_�„�,�+ What kind of Permit? (Check each box that applies 0 Lot or Road Segregation wilding 0 Critical Areas Stewardship Plan ❑ Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family ❑Garage Attached/Detached 0 Conditional Use[C(a), C(d),or C]** 0 Manufactured Home - 0 Modular • 0 Discretionary"D"or Unnamed Use Classification ❑ Commercial* 0 Special Use(Essential Public Facilities)** • Change of Use 0 Boundary Line Adjustment ❑ Address 0 Road Approach 0 Short Plat** 0 Home Business 0 Cottage Industry 0 Binding Site Plan** Propane ❑Long Plat** ❑ Oign 0 Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes" Use Consistency Analysis 0 Plat Vacation/Alteration** ❑ Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions** 0 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). )1OWNERSIGNATURE,_aQkA,,,..L_f Date: �J � Z— • 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 harrnless 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: o t .. �.�.t ..t 1 Date: 1 t I - I I Z 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-transf a responsib.lit 9.r a hering to and c9mplying with the ESA. The Applicant has read this disclaimer and signs and dates it below. gnature: I Date: 1 I ( 7 /f z- G:\PermitCenter\###FORMS###,XRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.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: GEERAL'CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: MAILING ADDRESS:\\ EMAIL: CONTRACTORS LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: El New a Wood Existing: 1 Sewer C Addition 1 Steel Proposed: Bank ri Community System C Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System Repair L Masonry — SEP Permit# _ Demolition C Other: Bedrooms: Water Supply: Existing: _ Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: ❑ Public Total: Name of System: • If this is a Commercial Protect 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 l No If this is a Propane T nk and/or Appliance Installation permit,mark all items below that apply: 1 Underground Tank bove ground Tank Size of Propane Tank:I Heat Stove I Cook Stove I Woodstove I Fireplace Insert I Hot Water Tank I Pellet Stove I Other 1,. 0,9 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 Office Use Only Amount Revision Main Floor Heated EH Bld App Review: -2nd Floor Heated Consistency Review: Other Heated Base fee: L� 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: $ I —t Receipt Number: 1! ✓'SC) Cash/Check Number: \i ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and materials foundation to finish 1 Initials: (:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc