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Home My WebLink AboutBLD2013-00167 BUILDING PERMIT APPLIC•ION BLD13-00167 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD13-00167 Received Date: 5/29/2013 SITE ADDRESS: 34 WOODLAND WAY PORT TOWNSEND, 98368 OWNER: G W NIK MARVIN PHONE: 360-379-5320 DONNA D MARVIN 34 WOODLAND WAY PORT TOWNSEND WA 98368-9595 OLYMPIC SUNSET ESTATES SHORT P SUBDIVISION: Block: Lot PARCEL NUMBER: 001273003 Section: 27 Township: 30 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 PROPANE TANK SWAP OUT TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP ALT 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: 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 $76.00 JLA 05/29/13 142130 Total: $76.00 APPROVE . MAY 2 9 2013 Jefferson Con;, • \\f;rfcmor4\rlofo\fnrmc\C RI n Ann PIA rr,4 F/70/9M4 • ! MECHANICAL AND DEMOLITION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD13-00167 Received Date 5/29/2013 SITE ADDRESS: 34 WOODLAND WAY Issue Date 5/29/2013 PORT TOWNSEND, 98368 APPLICANT: G W NIK MARVIN PHONE: 360-379-5320 DONNA D MARVIN 34 WOODLAND WAY PORT TOWNSEND WA 98368-9595 SUBDIVISION: OLYMPIC SUNSET ESTATES SHORT P Block: Lot: PARCEL NUMBER: 001273003 Section: 27 Township: 30N Ranqe: 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, G W NIK MARVIN PHONE: 360-379-5320 if different: DONNA D MARVIN 34 WOODLAND WAY PORT TOWNSEND WA 98368-9595 PROJECT DESCRIPTION: PROPANE TANK SWAP OUT 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 5/29/2014. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: BUILDING INSPECTION HOT-LINE 379-4455. REQUESTS MUST BE RECEIVED BY 3 PM THE DAY BEFORE THE INSPECTION IS NEEDED. Office Hours 9:00 a.m. -4:30 p.m. Monday-Thursday HOT LINE AVAILABLE 24 HOURS A DAY \\tidemark\data\forms\F_BLD_Permit_Propane.rpt 5/29/2013 ,c�w'Sc)N cc& JEFFERSON COUNTY • I . • r `4k r� DEPARTMENT OF COMMUNITY DEVELOPMENT `� 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax "�S Ner Ov www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: Project Description(include separate sheets as necessary): Tax Parcel Number: 0 C I —c?73 -Up 3 Property Size: t 3 a-e-- - (acres/square feet) Site Address and/or Directions to Property: 3`f 6Uaod (Q ,d t&- > fart 'row vu-end G(1A- 9�36, s Property Owner(s)of Record: Al,'K *- 6,vlric /7 f v,'n Telephone: (-3 Go) 3 7 g—5-3 2.0 Fax: email:dc rr.2a rnLt r v(a) C} rye; ,c Cy y� Mailing Address:_ Scz rnE aS �(� ,^ �J Applicant/Agent(if different from owner): iy‘ Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies ❑ Lot or Road Segregation ❑Building 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]** ❑ Manufactured Home .0 Modular • 0 Discretionary"D"or Unnamed Use Classification ❑ Commercial* 0 Special Use(Essential Public Facilities)** L Change of Use 0 Boundary Line Adjustment ❑ Address ❑Road Approach 0 Short Plat** ❑ Home Business ❑Cottage Industry 0 Binding Site Plan** A Propane S iv A(30 LongPlat** ❑ Sign 0 Plarinea Fturai Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** ❑ Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions** ❑ 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 ❑Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference ❑Tree Vegetation Request **ReqUa Pre-Application Please identify any other local, state or federal permits required for this proposal, if known: I hereby designate C , EA,'EX DESIGNATION OF AGENT �, to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE -CI"ljvu_ ->/ ;L/kLk-e,, 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 ap lication that he or she wants prior notice. Signature:- )al Date: 3 /`�71I—5 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 art 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-tr nsferable responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature. U-2.4,-e Date: ),4`j //3 0 • 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. II Signature:, M,f,7— fur Date: - /d`t/y 3 GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PI-tcNE: FAX:( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTORS LICENSE WAINS NUMBER NUMBER: —_- FAX:( ) ARCHITECT/ENGINEER: PHONE ( ) MAILING ADDRESS: EMAIL Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: Project Type: Existing: E Sewer Li Addition 0 Steel Proposed:❑ Wood Pro o ed: Bank ❑ Community System Total: Height: ❑ Individual System Alteration/Remodel ❑ Concrete _ SEP Permit# _ ❑ Repairmo ❑ Masonryther: Bedrooms: Water Supply: Demolition Other: Existing: Setback: ❑ Private well C Two Party Proposed: 0 Public Type of Heat: Total: Name of System: • If this is a Commercial Project you must answer the following: Number of ADA Parking Spaces: Number of Parking Spaces: Current: Proposed: 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: t Underground Tank 'Above ground Tank Size of Propane Tank: 'C}-/eat Stove i Cook Stove I Woodstove i Fireplace Insert X-lot Water Tank i Pellet Stove i Other Is this appliance being installed in a Manufactured I Mobile Home? Yes /0 . 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. S•uare Foota•e Current Proposed For Office Use Onl Amount Revision Main Floor Heated EH BId App Review: - 2`d Floor Heated Consistency Review: Other Heated Base fee: 76 (7)D Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: — Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL1(y. 00 Decks 911/Rd Approach fee: Other TOTAL: $"-7( O Receipt Number: Cash/Check Number: ESTIMATED COST(REQUIRED) Date: •Fair market value of all labor and materials foundation to finish Initials: 1