HomeMy WebLinkAboutBLD2013-00193 • S
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#: BLD13-00193 Received Date 6/24/2013
SITE ADDRESS: 441 PINECREST DR Issue Date 6/24/2013
PORT TOWNSEND, 98368
APPLICANT: JOHN MULLER PHONE: 713-589-3277
CHERI MULLER
441 PINECREST DR
PORT TOWNSEND WA 98368
SUBDIVISION: KALA POINT#7 Block: Lot:
PARCEL NUMBER: 965000276 Section: 27 Township: 30N Range: 01W
CONTRACTOR: AIR FLO HEATING COMPANY INC PHONE: 360-683-3901
221 W CEDAR
SEQUIM WA 98382
Contractor's License AIRFLI*206DG Expires 4/25/2014
OWNER, JOHN MULLER PHONE: 713-589-3277
if different: CHERI MULLER
441 PINECREST DR
PORT TOWNSEND WA 98368
PROJECT DESCRIPTION: REMOVE L.P. GAS FURNACE AND PUT IN HEAT PUMP SYSTEM.
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 6/24/2014.
REQUIRED INSPECTIONS:
Tank/Line/Appliance:
FinalApproval: �-��—�2 4{�\
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 6/24/2013
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JEFFERSON COUNTY
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� DEPARTMENT OF COMMUNITY DEVELOPMENT ■
J 1,� 621 Sheridan Street• Port Townsend•Washington 98368
u Fr 360/379-4450. 360/379-4451 Fax Iglaillimemumit
1EFFERSO�•'.'1"-.. www.coJefferson.wa.us/commdevelopment
DEPT.OF COMMUNITY :`, NT
' :8 : 'erm 'pplication MLA:
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i
Tax Parcel Number: Ruscroo o._--/ cp Property Size:
(acres/Square feet)
,Site Address and/or Directions to Property:
' What kind of Permit?(Check each box that applies
0Building . CI Crftical Areas Stewardship Plan
0 Demolition Permit 0 Variance(Minor,Major or Reasonable Economic Use)
pSingle Family 0 Garage Attached/Detached 0 Conditional Use[C(a).C(d),or CI ss`
0 Manufactured Home El Modular CI DisciVionary"D"or Unnamed Use Classification '
■ Special
0 Address 0 Road Approach 0 Short Plat"
0 HOME)Business 0 Cottage Industry El Binding Site Plan""
0 Sign 0 Planned Rural Residential Development(PRRD)/Arnendments**
0 Allowed'Yes"Use Consistency Analysis 0 Plat Vacation/Aiteration"
. 17:1 Change of Use 0 Boundary Line Adjustment Shoreline Master Program Exemption/Permit Revisions"
0 Temporary Use 0 Wireless Telecommunication• 0 Comprehensive Plan/UDC/Land Use District Map Amendment
0 Site Plan Approval Advance DeterminatIOn(SPAAD)• 0 Shoreline Management Substantial Development" .Shoreline Management Variance
Date:CD Forest Practices Act/Release,of Six-Year Moratorium 0 Jefferson County Shordline Master Program Amendment
•May require a Pre—.Application Conference 0 Tree Vegetation Request
• Please identify any other focal,state or federal permits required for this proposal,if frown:
I hereby designate ',nor 1 1.,:,i e-J. 11.13 to act as my agent In matters relating to thl•i;ppr.ttion for permit(s).
OWNER SIGNATURE i „eta 4.4,.. ,
it
furtherBy signing this appliostkin to • .the owner/agent attests that ti)e intomiation provided herein,and in any attachments,is true and correct to the bast of
his,her or its knowledge. •• 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••ng null and void. . _
expenses which may in any way:•••• e against Jefferson County as a result of or in consequence of the granting of this permit.
I further agree to provide access,:••right f entry to Jefferson'County and its employees,representatives or agents for tho sole purpose of apprication
review and any required later in", • ft
� applicant
Signature: hi r •
Date: I
The action or actions Appilloat will undertake as a result of the Issuance of this permit may negatively impact upon•no or ore threatened or
. endangered species and mild lead to a potential lake a 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 sipplicant that the actions that will be undertaken because this
permit has boon Issued wNI not -•ate the ESA Any individual,group or agenoy can file a lawsuit on behalf of an endangered species regarding your
action(s)oven N you are In co •• :e nce '-' efferson County development code:The Applicant acknowledges tha :,s • or it holds Individual
arid nomtransferable • ' r. a yinq with the ESA. The Applicant has road this d-•- i&i.,•r and .-t na and dates it below.f�.�
G,\PeauitCearer\###FO• . • •\DRD FORMS\Mrater Pemi1App&ation 5.29-OS.doo
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• 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 contractotS 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: 4 c FAX:
MAILING ADDRESS: ^/�, ,_F'k� FLO 0 ' l li t Noo 3 O,- 5b S4• 5 6c63 3d 1 I
d-�] W-C�'i bh�s-, co)"" tw IN EMAIL: £ /V�.®
CONTRACTOR'S LICENSE WAINS
NUMBER: f1 R F LA ')-0(a 0 C"- NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New 0 Wood Existing: 0 Sewer
❑ Addition 0 Steel Proposed: Bank ❑ Community System
VA--Alteration/Remodel 0 Concrete Total: Height: ❑ Individual System
❑ Repair 0 Masonry SEP Permit#
O Demolition 0 Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well 0 Two Party
Ty a of eat:, Proposed: ❑ Public
C... 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:
1 Underground Tank 1 Above ground Tank Size of Propane Tank:
I Heat Stove 1 Cook Stove I Woodstove 1 Fireplace Insert I Hot Water Tank 1 Pellet Stove I 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.
S•uare Foota•e Current Pro••sec R y f .
Main Floor Heated _ ik F r ._�€- rs.-» ,aa ��_k�.xttlwi.„ft��_L _2,,�_ �4.<.`,:�'.B.'_ ... .._ .,.
by EH Bld App Review:
2na Floor Heated t ' Consistency Review:
-
Other Heated -- Base fee:
Mezzanine Additional Section:
Heated Basement L- Plan Check fee: - 0 1 J \J t: --fj,
Unheated Basement -im'$, +-,
x , r State Surcharge fee:
Other Unheated Pot Water Review fee: ,• L.!Ur 2 I ffia
Garage/Carport ,u`•a`t-,1- :n SUBTOTAL y `'( �`�
l JEFFERSON COUNTY
Decks °'.' ;, 911/Rd Approach fee:
DE)-7OFt on"ih�uN Ir utvtlur'MtNI
Other L1 ,C P J kp ;'41 i TOTAL:
6 P I y 6a3 A Receipt Number: [L t2 LC6,
Cash/Check Number: LI
ESTIMATED COST(REQUIRED) Date: 1 r
.Fair market value of all labor and materials foundation to finish 6- ,) '1/ ( i _
`lam 1 i4- ia:3- rD Initials:
G:\PerrotCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc