HomeMy WebLinkAboutBLD2003-00608 •
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 #: BLD03-00608 Received Date 9/26/2003
SITE ADDRESS: 60 RANDOLPH ST Issue Date 9/26/2003
PORT HADLOCK, 98339
APPLICANT: ROBERT N WILLIAMS PHONE:
PO BOX 187
PORT HADLOCK WA 983390187
SUBDIVISION: PORT HADLOCK Block: Lot:
PARCEL NUMBER: 989400504 Section: 2 Township: 29N Range: 01W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPI983O6 Expires 09/26/2004
OWNER, ROBERT N WILLIAMS PHONE:
if different: PO BOX 187
PORT HADLOCK WA 983390187
PROJECT DESCRIPTION: Above 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:
[ ] Tank/Line/Appliance:
[ ] FinalApproval: {'rim/4.osJ)�e-
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
I:\F_BLD_Permit_Propane.rpt 10/29/19c
UILDING PERMIT APPLICA•ON B RDOe 00w p608
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00608 Received Date: 9/26/2003
SITE ADDRESS: 60 RANDOLPH ST
PORT HADLOCK, 98339
OWNER: ROBERT N WILLIAMS PHONE:
PO BOX 187
PORT HADLOCK WA 983390187
SUBDIVISION: PORT HADLOCK Block: Lot:
PARCEL NUMBER: 989400504 Section: 2 Township: 29 N Range: 01 W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTP198306 Expires 09/26/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION Above 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 By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 CJZ 09/26/03 60602
Total: $47.00
JEFFERSON COUNTY COMMUEVELOPMENT,621 SHERIDAN ST,PORT TOWND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* Above Ground PROPANE TANK HEAT STOVE HOT WATER TANK
WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE
OTHER(Please Specify)
Is this appliance(htg stove, hot water tank,furnace, etc.) to be installed in a Manufactured/Mobile Home3
YES g4s- NO
SITE ADDRESS(911#/Road Name):
60 ! eh St•
Port liQo/)o G� w . ZIP 9 S 3 3 9
9 DIGIT PARCEL ID NUMBER 7$`7 ` LI00 - . C)
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT Mountain Propane PHONE 3 ASS- 6 STS 3
265 Chimacum Rd.
MAILING ADDRESS
Port Hadlock,WA 98339
I ZIP c '
PROPERTY OWNER Job•erJ ttJi i/ QH-iS// ' PHONE 3'- /q67
MAILING ADDRESS Y , 0 f f Q)( ) JD -Port cylci.✓/ock f w /7d
ZIP 9s ,3339
CONTRACTOR Mountain Propane PHONE 3$S- grs 3
265 Chimacum Rd.
MAILING ADDRESS Port Hadlock,WA 98339
ZIP
STATE LICENSE# (CLi T )�2 gS 306 EXP.DATE 7 `-" 6
FEDERAL I.D.# LJ 2O3, c (j SS
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 plicant's property or structure shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE DATE 7 / /
FOR OFFICE USE ONLY
BASE FEE RECEIPT#
CONSISTENCY REVIEW CASH/CK#
TOTAL DATE / /
*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.
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