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Home My WebLink AboutBLD2013-00137• BUILDING PERMIT APPLILION BLD13-00137 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD13-00137 Received Date: 5/7/2013 SITE ADDRESS: 2261 OLD GARDINER RD SEQUIM, 98382 OWNER: DISCOVERY BAY LSEHLDRSASSOC PHONE: 360-797-7222 2261 OLD GARDINER RD SEQUIM WA 983828718 SUBDIVISION: Block: Lot: + PARCEL NUMBER: 002353002 Section: 35 Township: 30 N Range: 02 W CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTPI983O6 Expires 9/26/2013 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI' new 120 gallon propane tank TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2009 HEAT BASE: HEAT TYPE: OCCUPANCY: 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 By: Date: Receipt: Approved/Date Permit $228.00 CJZ 05/07/13 142047 /� Total: $228.00 APPROVED MAY - '' 2013 Jefferson County DCD APPROVED MAY - '` 2013 Jefferson County DCD �\+Act.,t.i.\.1of.1fn...,e\r Ain Ann PH...t F/7/'Jl11Z izr w4`'(6°N %�� JEFFERScOUNTY • DEPARTMENT OF COMMUNITY DEVELOPMENT `' ''4 621 Sheridan Street •• Port Townsend ••Washington 98368 i� 360/379-4450 . 360/379-4451 Fax q �%!�0 www.co.jefferson.wa.us/commdevelopment 'HIN , MAY - 1 2013 ;Master Permit Application Ai. ____•Project Description (include separate sheets as necessary): JCOMM NI LOUNW zr. A/7 /2 /I e ode L C DEPT.Of COMMUNITY DEVELO Tax Parcel Number: p C /' C Property Size: `�°7 (6, 36,K S3 (acres/square feet) Site Address and/or Directions to Property: 315Co ✓ell y £67 R ✓ P.4e k C�a4 aZ� i old �A2.0INe,2 RA. sE7u,.n, Lc)R•. ?S-3 2-- /, 7L 4/6 Property Owner(s)of Record: Gas •/ 474L.e p i,vE}L 44..,d J usl,y S,7/e e Telephone:4;7p-.13J-a. ( S Fax: / email J.S3tq�9oioi�•Mailing Address: (SA m F. 2 ! // Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies ❑Building ❑ Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use) ❑Single Family ❑ Garage Attached/Detached ❑ Conditional Use[C(a), C(d),or C]"* ❑ Manufactured Home Cl Modular El Discretionary"D"or Unnamed Use Classification ❑ Commercial* ❑ Special Use(Essential Public Facilities)** ❑ Change of Use ❑ Boundary Line Adjustment ❑ Address ❑ Road Approach Cl Short Plat** ❑ Home Business ❑ Cottage Industry ❑ Binding Site Plan** 1&1Dropane ❑ Long Plat** ❑Sign ❑ Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis ❑ Plat Vacation/Alteration** ❑ Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions"* ❑ Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Substantial Development** ❑Temporary Use ❑ Shoreline Management Variance ❑Wireless Telecommunication* ❑ 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 **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 eQ� A 4, to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: S/(Q4? 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 applicati• h-.t e or sh- ants prior notice. / Signature:"' _ Date: SA,/0 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 y fl re in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transfera e es onsibility adhering to and complying with the ESA. The Applicant has read this disclai era d signs and dates it below. Signature: el' Date: `SCv�l3 G:\PermirCenter\###FORMS###\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: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: Art Q-t�t-t ..—)LaT L—B--12--_ ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: New ❑ Wood Existing: ❑ Sewer Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System Li Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ 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: Underground Tank 1 Above ground Tank Size of Propane Tank: i Heat Stove i Cook Stove i Woodstove i Fireplace Insert 1 Hot Water Tank 1 Pellet Stove 1 Other Is this appliance being installed in a Manufactured f 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: 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 TOTAL: $ Receipt Number: l.' '1 qc Cash/Check Number: l ESTIMATED COST(REQUIRED) Date: •Fair market value of all labor and materials foundation to finish S-1- 13 Initials: e G:\PermitCenter\###FORMS###\DRD FORMS\Mastcr Permit Application 5-29-08.doc ID 0 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 #: BLD13-00137 Received Date 5/7/2013 SITE ADDRESS: 2261 OLD GARDINER RD Issue Date 5/7/2013 SEQUIM, 98382 APPLICANT: DISCOVERY BAY LSEHLDRS ASSOC PHONE: 360-797-7222 2261 OLD GARDINER RD SEQUIM WA 983828718 + SUBDIVISION: Block: Lot: PARCEL NUMBER: 002353002 Section: 35 Township: 30N Range: 02W CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTPI983O6 Expires 9/26/2013 OWNER, DISCOVERY BAY LSEHLDRS ASSOC PHONE: 360-797-7222 if different: 2261 OLD GARDINER RD SEQUIM WA 983828718 PROJECT DESCRIPTION: new 120 gallon propane tank 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 5/7/2014. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval:y�. ("2`Y -t, 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_B LD_Permit_Propane.rpt 5/7/2013