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Home My WebLink AboutBLD2003-00607 BUILDING PERMIT APPLICIION BLD0 00viewp607 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD03-00607 Received Date: 9/26/2003 SITE ADDRESS: 241 S KEEL WAY PORT LUDLOW, 98365 OWNER: MARK A WYSE PHONE: 6044 E HOLLYHOCK ST PHOENIX AZ 850186722 SUBDIVISION: LUDLOW POINT VILLAGE DIV 2 Block: Lot: 6 PARCEL NUMBER: 969500006 Section: 17 Township: 28 N Range: 01 E CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTP1983O6 Expires 09/26/2004 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOt Abouve Ground Propane Tank TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION MAIN: CODE EDITION: 1997 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: PARCEL TAGS: YES NO BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA Exist: Exist: Wetland Erosion Prop: Prop: Seismic Streams Total: Total: Flood Way Floodplain Routing Date: F&W Landslide Shoreline Aquifer . Forest: Commercial Rural Type Amount Paid Bv: Date: Receipt: Approved/Date Propane Tanks/Stoves $47.00 CJZ 09/26/03 60202 Total: $47.00 JEFFERSON COUNTY COMMU•DEVELOPMENT,621 SHERIDAN ST.PORT TOWARD WA 98368 PH: (360)379-4450 INSTALLATION PERMIT APPLICATION MARK ALL ITEMS BELOW THAT PERTAIN TO THISINSTALLATION Underground PROPANE TANK* 1� Above Ground PROPANE TANK HEAT STOVE HOT WATER TANK WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE r I,---OTHER(Please Specify) Is this appliance (htg stove, hot water tank,furnace, etc.)to be installed in a Manufactured/Mobile Home? YES NO SITE ADDRESS(911#/Road Name): 0, 4I Si Keel woy Port 1- fQ/1ol.✓ , r.� r4 , ZIP 4F5 365— n 9 DIGIT PARCEL ID NUMBER �7 6 '9 - .5o0 - 0 6j Legal Description: Subdivision Name Block Lot(s) Section Township North, Range WM APPLICANT Mountain Propane PHONE 3 S S - 6 S S 3 265 Chlmacum Rd. MAILING ADDRESS Port Nadiock,WA 98339 ZIP PROPERTY OWNER 'J )) 410 J y) IO toys PHONE 43 "2 " 4016 MAILING ADDRESS a.14 ) 5 ) tom l w a y Port L tAglow l.e/ 4 ZIP 30� CONTRACTOR Mountain Propane PHONE 3 SS — d 5F5 3 265 Chtmacum Rd. MAILING ADDRESS Port IadIock,WA 98339 ZIP STATE LICENSE# /Y a 1,>fl 7" Pi 7 O s 306 EXP.DATE 7 p - 26 --by FEDERAL I.D.# 1-/f - 0 S6 6-3-- By signing the application form,the applicant/owner attests that the information provided herein is true and correct to the best of their knowledge. Any material falsehood or any omission of a material fact made by the applicant/owner 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 it's employees,representatives or agents for the purpose of application review and any required later inspections. Access and right of entry to the licant's property or structure shall be requested and shall occur during regular business hours.G APPLICANTS SIGNATURE ,f/r/" (� DATE 7 / / 0 3 Ai FOR OFFICE USE ONLY n BASE FEE RECEIPT# (r o o� CONSISTENCY REVIEW CASH/CK# 5 3 14 TOTAL DATE '1 /o / *Underground Propane Tank applications require additional information to be submitted. 0 V E R Please contact our office at 360-379-4450 if the back of this application is blank. g:\permitcenter\forms\bldg forms\install-revised 10-23-02.doc S 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 #: BLD03-00607 Received Date 9/26/2003 SITE ADDRESS: 241 S KEEL WAY Issue Date 9/26/2003 PORT LUDLOW, 98365 APPLICANT: MARK A WYSE PHONE: 6044 E HOLLYHOCK ST PHOENIX AZ 850186722 6 SUBDIVISION: LUDLOW POINT VILLAGE DIV 2 Block: Lot: PARCEL NUMBER: 969500006 Section: 17 Township: 28N Range: 01 E CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTP198306 Expires 09/26/2004 OWNER, MARK A WYSE PHONE: if different: 6044 E HOLLYHOCK ST PHOENIX AZ 850186722 PROJECT DESCRIPTION: Abouve Ground Propane Tank 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 09/26/2004. REQUIRED INSPECTIONS: [ ] - ine/: ppliance: dX /a/3A3 [ ] inalApprov �/� kor e/b /o/3/3A 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 is\F_BLD_Permit_Propane.rpt 10/29/19£