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Home My WebLink AboutBLD2012-00399 T� 111) eV. 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#: BLD12-00399 Received Date 12/12/2012 SITE ADDRESS: 25 SEA VISTA PL Issue Date 12/12/2012 PORT LUDLOW, 98365 APPLICANT: JACK L MANNING PHONE: 360-437-9522 KATHLEEN A MUIR 25 SEA VISTA PL PORT LUDLOW WA 98365-9586 SUBDIVISION: TEAL LAKE VILLAGE Block: Lot: PARCEL NUMBER: 998700030 Section: 21 Township: 28N Range: 01 E CONTRACTOR: FAST WATER HEATER COMPANY PHONE: 425-636-7054 12601 132NDAVE NE KIRKLAND WA 98034 Contractor's License FASTWWH948BC Expires 1/4/2014 OWNER, JACK L MANNING PHONE: 360-437-9522 if different: KATHLEEN A MUIR 25 SEA VISTA PL PORT LUDLOW WA 98365-9586 PROJECT DESCRIPTION: 001 i LU/17.J 17 nt_ 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 12/12/2013. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: -- - - 13 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 12/12/2012 1 litUILDING PERMIT APPLICA IT'i`O BLD12-00399N Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD12-00399 Received Date: 12/12/2012 SITE ADDRESS: 25 SEA VISTA PL PORT LUDLOW, 98365 OWNER: JACK L MANNING PHONE: 360-437-9522 KATHLEEN A MUIR 25 SEA VISTA PL PORT LUDLOW WA 98365-9586 TEAL LAKE VILLAGE SUBDIVISION: Block: Lot: PARCEL NUMBER: 998700030 Section: 21 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 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: 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 Permit $222.00 JLA 12/12/12 139824 Total: $222.00 A DEC )Z 2012 Jefferson County Planninn & Building Department \\firlemorL\rl•n4e\fnrmc\G RI fl Ann PH rnf 19/19/9f 1) • 614538 ,.3 47 ON cO JEFFERSON COUNTY .1:. DEPARTMENT OF COMMUNITY DEVELOPMENT t' '' "+ '' 621 Sheridan Street• Port Townsend•Washington\,,,,,.7-4%** ,' 360/379-4450 • 360/379-4451 Fax .gOrSp www.cojefferson.wa.us/commdevelopment zim Master Permit Application MLA: Project Description(include separate sheets as necessary): Remove/Replace Electric Water Heater Tax Parcel 998700030 Property Number: Size: (acres/square feet) Site Address and/or Directions to Property: 25 SEA VISTA PL Property Owner(s)of Record: MUIR, KATHY Telephone: (360)437-9522 Fax: email: Mailing Address: 25 SEA VISTA PL PORT LUDLOWWA 98365 ApplicantlAgent(If different from owner): FAST WATER HEATER COMPANY Telephone: 425-636-7054 Fax: 425-636-7055 emairfCYNCTUr.com Mailing Address: What kind of Permit?(Check each box that applies building 0 Variance(Minor,Major or Reasonable Economic Use) ❑ Demolition Permit ❑Conditional Use[C(a),C(d),or C]"" X1 Single Family 0 Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home ❑ Modular ❑Special Use(Essential Public Facilities)** ❑ Commercial* 0 Boundary Line Adjustment ❑ Change of Use ❑Short Plat** ❑ Address 0 Road Approach ❑Binding Site Plan*"` ❑Home Business 0 Cottagelndustry ❑Long Plat** O Propane ❑Planned Rural Residential Development(PRRD)/Amendments** ❑Sign ❑Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions** O Stormwater Management ❑Shoreline Management Substantial Development** ❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Variance ❑Temporary Use D Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment ❑Forest Practices Act/Release of Six-Year Moratorium ❑Tree Vegetaion Request *May require a Pre—Application Conference **Requires aPre-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 pemiit(s). OWNER SIGNATURE See attached _ Date: r I 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 it's 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 attomey'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 lime of the application that he or she wants prior notice, Signature: Date: 11/23/12 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 actions)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: 11/23/12 C\Documents and Settings\eared\Local Settings\Temporary Internet Files\OLKII6\Master Permit Application t2-19.200f.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: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: FAST WATER HEATER COMPANY ( ) 425-636-7054 ( )425-636-7055 MAILING ADDRESS: 12601 1321OD AVE NEKIRKLAND,WA 98034 EMAIL: fastwaterhPatPr Rom CONTRACTOR'S LICENSE WAIN NUMBER: FASTWWH948BC NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: ❑ Sewer O Addition 0 Steel Proposed: Bank ❑ Community System OXAlteration/Remodel 0 Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry _____ SEP Permit# ❑ Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well 0 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: CI Underground Tank [I Above ground Tank Size of Propane Tank: ❑Heat Stove ❑Cook Stove ❑Woodstove 0 Fireplace Insert 0 Hot Water Tank 0 Pellet Stove 0 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 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: gnu 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 Water Heater 1 TOTAL: $ 2'ZZ- Receipt Number: 1? O L). Cash/Check Number: I, r 1 rA 1 1 4S0 ESTIMATED COST(REQUIRED) Date: Z-I L IL .Fair market value of all labor and materials foundation to finish l� _ a Q 0 Initials: c� CAI-Documents and Settings\coat\Local Setting\Temporary Internet Files\OLK86\Master Permit Application 12-19-2006.doc