HomeMy WebLinkAboutBLD2003-00609 o
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 #: BLD03-00609 Received Date 9/26/2003
SITE ADDRESS: 780 RAINIER LN Issue Date 9/26/2003
PORT LUDLOW, 98365
APPLICANT: LEROY A BAUNSGARD PHONE:
KAREN J BAUNSGARD
PO BOX 706
KINGSTON WA 98346 68
SUBDIVISION: PORT LUDLOW NO. 3 Block: Lot:
PARCEL NUMBER: 990700068 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, LEROY A BAUNSGARD PHONE:
if different: KAREN J BAUNSGARD
PO BOX 706
KINGSTON WA 98346
PROJECT DESCRIPTION: PROPANE HEAT STOVE
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: PROPANE RE52T 5-r vES OK l2// erg
[ ] FinalApproval: D' -4,1*- ! - 11111//€3
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.
• BUILDING PERMIT APPLI•TION BLD03-00039
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00609 Received Date: 9/26/2003
SITE ADDRESS: 780 RAINIER LN
PORT LUDLOW, 98365
OWNER: LEROY A BAUNSGARD PHONE:
KAREN J BAUNSGARD
PO BOX 706
KINGSTON WA 98346
SUBDIVISION: PORT LUDLOW NO. 3 Block: Lot: 68
PARCEL NUMBER: 990700068 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 MOUNTPI983O6 Expires 09/26/2004
REPRESENTATIVE: PHONE
PROJECT DESCRIPTIOr PROPANE HEAT STOVE
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION
CODE EDITION: 1997 ADD'L: HEAT TYPE:
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
CONST TYPE: OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK:
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 ZAN 09/26/03 60113
Total: $47.00
JEFFERSON COUNTY COMMIIIFY DEVELOPMENT,621 SHERIDAN ST,PORT TO,END 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 Home?
YES NO
SITE ADDRESS(911 #/Road Name):
7tO 1A� /
/0,2--r- LL 1> ZIP '?p tg 6 S
'9 DIGIT PARCEL ID NUMBER D7 0 67°G e
Legal Description:
Subdivision Name pc,.27" L ..-rjj o - Block Lot(s) (E,
Section Township North, Range WM
APPLICANT LG t� .-1/vS ,Q PHON(3 0)2 7 3 Q S' 0
MAILING ADDRESS /�0 (/� s`s t i�� L ,Lp
/`p/L-T ✓t�C c�a-c� l t ,r4 ZIP qe 36 S
PROPERTY OWNER _ PHONE
MAILING ADDRESS M `—
ZIP
CONTRACTOR PHONE
MAILING ADDRESS
ZIP
STATE LICENSE# EXP.DATE
FEDERAL I.D.#
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 Co my d' s employees,representatives or agents for the purpose of application review and any required later
inspections. Access and right of entry to y o st u shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE DATE ' /2-6 / U
`� FOR OFFICE USE ONLY
BASE FEE 7 RECEIPT#
CONSISTENCY REVIEW CASH/CK#
TOTAL DATE / /
*Underground Propane Tank applications require additional information to be submitted. 0 V E R 10- 10-
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