HomeMy WebLinkAboutBLD2021-00167 - MECHANICALDate: 4/9/2021
Invoice ID: 2021BLD2021-00167
JEFFERSON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street | Port Townsend, WA 98368
360-379-4450 | email: dcd@co.jefferson.wa.us
www.co.jefferson.wa.us/commdevelopment
Invoice
Date Due:
5/9/2021
REMIT TO:
BILLING ADDRESS:
Please return the above portion with your payment
Permit 97.00
Tech Fee 4.85
$101.85Total Amount Due:
Jefferson County DCD
621 Sheridan St.
Port Townsend, WA 98368
DAVID J MC LEOD
PORT LUDLOW WA 98365-9618
650 MONTGOMERY LN
Permit Number: BLD2021-00167
Permit 97.00
Tech Fee 4.85
Total Amount Due:$101.85
Payment is accepted by cash, check, debit or credit card (Visa, Mastercard, Discover).
To pay by credit card, go to
http://www.co.jefferson.wa.us/617/Credit-Card-E-Check-Payments-for-Permits, and click on the
"Online Credit Card & echeck Payments" link on the left side of the page.
For questions: call 360-379-4450.
Is this permit for a mobile or manufactured home? *
Is this permit application for a solar panel installation? *
Does your project include any fixtures with a natural gas/propane/oil fuel source? *
Is this permit application for a propane tank installation? *
I understand that propane is prohibited in hazardous locations such as basements or pits or anywhere “heavier-than-air” gas can unsafely collect. *
Brief description of your project
Parcel # *
Parcel number where the work will be performed. Parcel number is mandatory. Please use the Parcel Lookup Tool to find your parcel number if you do not know it.
Property Owner's Name *
Property Owner's Mailing Address *
Property Owner's Phone Number *Property Owner's Email Address *
Are you currently or will you be working with an agent on your behalf? *
Are you currently or will you be working with a contractor for your project? *
Have you determined which contractor you are using for this project?
Property Owner's Information
Project Contact's Name *
Project Contact's Company Name *
Project Contacts
Is this parcel within Unincorporated Jefferson County? *
This means the parcel is located within Jefferson County, but not located within CITY LIMITS OF Port Townsend.
Mechanical Permit
Steps in the Permit Process: 1) Review required submittal items to ensure all information is completed prior to submitting application. 2) Mechanical Permits can be mailed into our office-and do not require
an appointment. 3) Fees are due at time of submittal, Mechanical permits are generally issued within 5 business days.
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Installation of 125 gallon upright propane tank and lines. Sunshine propane has done a sight survey and has indicated what corrections need to be made to insure code compliance.
990420055
David McLeod
650 Montgomery Lane
Port Ludlow Washington 98365-9618
(360) 437-9276 gunnermacc1@msn.com
Yes No
Yes No
Yes No
Please include your contractor information in the "Additional Contacts" section on the next page.
Contact 1
Whitey Johnson
Whitey Johnson General Contractor, Inc.
Project Contact's Mailing Address *
Project Contact's Phone Number *Project Contact's Email Address *
Role in this Project *
License # *Expiration Date *
Project Contact's Name *
Project Contact's Company Name *
Project Contact's Mailing Address *
Project Contact's Phone Number *Project Contact's Email Address *
Role in this Project *
License # *Expiration Date *
Add ContactAdd Contact
Heat Source *
Indicate Quantity of NEW Fixture Types Below *
How many gallons is the tank? *
Is the tank above ground? *
Mechanical Permit Details
PO Box 65470
port Ludlow Washington 98365
(360) 265-0604 whiteyjohnson@comcast.net
Agent/Representative Contractor
WHITEJG952DN 3/15/2023
Contact 2
Shawn Coady
SUNSHINE PROPANE
10853 Rhody Drive
Port Hadlock Washington 98339
(360) 385-5797 info@sunshinepropane.com
Agent/Representative Contractor
SUNSHP*814KT 5/30/2021
Electric Heating Oil Propane Wood
0 1 2 3 4 5 6+
FAN (Bath Fan and/or Exhaust Fan)*
CLOTHES DRYER (Clothes Dryer with Exhaust Vent)*
COOK STOVE (Cook Stove, Range Hood Exhaust *
FIREPLACE - GAS (Fireplace-Gas or Gas Log Insert)*
FIREPLACE - WOOD (Fireplace-wood, Wood Stove, or Pellet Stove)*
ELECTRIC FURNACE (Electric Furnace or HP +/- Ducting)*
PROPANE (LP) GAS FURNACE (Propane Furnace +/- Ducting)*
WATER HEATER - GAS (Gas WH Vent and Combustion Air)*
GAS PIPE SYSTEM (Gas Pipe System LPG/Oil)*
PROPANE TANK (LP Fuel Tank)*
HEAT PUMP *
GENERATOR *
AIR CONDITIONER *
125
Yes No
Site Plan *
Submittal Items
Fees
Confirm Understanding *
I understand that an estimate of my permit fees have been calculated for me and that upon review of my application, more fees may be invoiced to me. I will write down (or otherwise note) the Total Fees, above, and enter the amount into the "Amount" box that will appear on next
webpage (after I hit the "Submit and Pay" button). I also understand that a convenience fee is charged by the credit card processor for all online payment transactions and that I can reduce the convenience fee by choosing the e-check option rather than using the credit or debit card option.
Print Name *
By printing my name above, I, as the owner/agent, attest that the information provided herein, and in any attachments, is true and correct to the best of my 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 making
any issued permit null and void.
I further agree to that all activities I intend to undertake or complete associated with this permit will be performed in compliance with all applicable federal, state and county laws and regulations and I 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. Applicant may request notice of the County’s intent to enter upon the property for visits related to this application and subsequent permit issuance.
Provide a general site plan showing propane tank, lines, and distance from tank (setbacks) to all existing structures.This site plan may be hand drawn and is only used to help the inspectors locate the tank
easily. Propane tanks over 125 gallons require a minimum setback of 10 ft. from property line and buildings, and a site plan must be submitted with the application showing the setbacks.
or drag files here.
Scan_0002.pdf
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Mechanical Permit Fee $291.00
Propane - Lines, Tank, and appliance (add'l $97.00)$97.00
Project Scanning Fee $24.00
Technology Fee $20.60
TOTAL FEES $432.60
I understand
David McLeod