HomeMy WebLinkAboutBLD2003-00612 • •
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 #: BLD03-00612 Received Date 9/29/2003
SITE ADDRESS: 694 BYWATER WAY N Issue Date 9/29/2003
PORT LUDLOW, 98365
APPLICANT: JOHN W CARTHUM TRSTE PHONE:
LORI E CARTHUM TRUSTEE
694 BYWATER WAY
PORT LUDLOW WA 983659237 18
SUBDIVISION: BRIDGE VIEW ESTATE TR DIV III Block: Lot:
PARCEL NUMBER: 821355030 Section: 35 Township: 28N Range: 01 E
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CCOQCHSIN9790Z Expires 09/06/2004
OWNER, JOHN W CARTHUM TRSTE PHONE:
if different: LORI E CARTHUM TRUSTEE
694 BYWATER WAY
PORT LUDLOW WA 983659237
PROJECT DESCRIPTION: Under 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 09/29/2004.
REQUIRED INSPECTIONS:
[ ] "k/ ine/Appliance: (//� `��1Nk OK /U 7,k*
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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 10/29/19
BLD03-00612
BUILDING PERMIT APPLICATION Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00612 Received Date: 9/29/2003
SITE ADDRESS: 694 BYWATER WAY N
PORT LUDLOW, 98365
OWNER: JOHN W CARTHUM TRSTE PHONE:
LORI E CARTHUM TRUSTEE
694 BYWATER WAY
PORT LUDLOW WA 983659237
SUBDIVISION: BRIDGE VIEW ESTATE TR DIV III Block: Lot: 18
PARCEL NUMBER: 821355030 Section: 35 Township: 28 N Range: 01 E
CONTRACTOR: CENEX SUPPLY & MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CCOQCHSIN9790Z Expires 09/06/20C
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI` Under 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:
Propane Tanks/Stoves $47.00 CJZ 09/29/03 60204
Total: $47.00 SEP 2 9 2003
Jefferson County Planning
& Building Department
14/(//
JEFFERSON COUNTY COMMUNI•VELOPMENT,621 SHERIDAN ST.PORT TOWNS•WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
y, 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 X,. NO
SITE ADDRESS(911#/Road Name):
(061 44 %yvvGL-1--e-r- o
Tor-1 dl
�✓ ZIP g83CD
9 DIGIT PARCEL ID NUMBER 13 55- 0 30
Legal Description: , r C7
Subdivision Name Br1 C V)etp EStzi-e. 'mu-5 �I V' / Block Lot(s)
Section Township North, Range WM
APPLICANT Lo r( John f-Jiu r'YL PHON(3(2U) 437 12 12
MAILING ADDRESS lO 4 ey tivi -I 1jJ /
Thr-f- L.tth fOUJ ) f T /19 ZIP 6 3&,5
PROPERTY OWNER 7U? QS PHONE
MAILING ADDRESS
�/ ZIP
CONTRACTORCert�J" PHONE
MAILING ADDRESS J ,, �/
it j' F7ct.00_. f(�(%�. 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 ent 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... -nt's prope or str tur hall be requested and shall occur during regular business hours. 9
APPLICANTS SIGNATURE I ' ( . DATE ! /cc' / D 3
_FOR OFFICE USE ONLY 41. ����
BASE FEE 2 '9, RECEIPT# /�"'*'"'�
CONSISTENCY REVIEW c J.6° CASH/CK# ��r4�p
TOTAL .I® DATE / / 3
*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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