HomeMy WebLinkAboutBLD2003-00626 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 #: BLD03-00626 Received Date 10/2/2003
SITE ADDRESS: 62 PUGET LOOP Issue Date 10/2/2003
PORT LUDLOW, 98365
APPLICANT: SUSAN M NELSON PHONE:
62 PUGET LOOP
PORT LUDLOW WA 983659707
55
SUBDIVISION: PORT LUDLOW NO 1 AREA 1 Block: Lot:
PARCEL NUMBER: 990400155 Section: 9 Township: 28N Range: 01 E
CONTRACTOR: FERRELLGAS PHONE: (360)779-7567
646 SO 3RD AVE
SEQUIM WA 98382
Contractor's License FERRELP055LH Expires 08/01/2004
OWNER, SUSAN M NELSON PHONE:
if different: 62 PUGET LOOP
PORT LUDLOW WA 983659707
PROJECT DESCRIPTION: Above Ground Propane Tank & Fireplace Insert
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 10/02/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: A)Ki !�!,'� '1 - C�15 //��C=IZT O
[ ] FinalApproval: /f/24/ 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
UILDING PERMIT APPLICA BLD03-00626
N Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00626 Received Date: 10/2/2003
SITE ADDRESS: 62 PUGET LOOP
PORT LUDLOW, 98365
OWNER: SUSAN M NELSON PHONE:
62 PUGET LOOP
PORT LUDLOW WA 983659707
SUBDIVISION: PORT LUDLOW NO 1 AREA 1 Block: Lot: 55
PARCEL NUMBER: 990400155 Section: 9 Township: 28 N Range: 01 E
CONTRACTOR: FERRELLGAS PHONE: (360)779-7567
646 SO 3RD AVE
SEQUIM WA 98382
Contractor's License FERRELP055LH Expires 08/01/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION Above Ground Propane Tank & Fireplace Insert
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 10/02/03 60222
Total: $47.00
JEFFERSON COUNTY COMMUN,EVELOPMENT,621 SHERIDAN ST,PORT TOWN WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* X Above Ground PROPANE TANK HEAT STOVE HOT WATER TANK
WOODSTOVE X 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):
C 2 PGtKE fi Loo
Pofq- l-about.) 0- ZIP qr 365
9 DIGIT PARCEL ID NUMBER r(10 00 /55
Legal Description: 0Ci 1�
Subdivision Name CL'\" L-- ,v4-4- Block Lots)
Section Township North, Range WM
APPLICANT v "' � `V` . 6/50\1 PHONE
MAILING ADDRESS (O Z Pta 9-ik Loop
f
/44 ow kJ' `iY3r SJ ZIP
PROPERTY OWNER as cilnytt PHONE
MAILING ADDRESS
I�,� L1,-, , / ZIP
CONTRACTOR Er �i��d `Lt r�r S T �Y(PCf PHONE
MAILING ADDRESS
Fold $ (kJ A I CL--1L5et_) LA- 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 rig 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 h a licant's� property or struct re sh be requested and shall occur during regular business hours.
J� ► I�( . „
APPLICANTS SIGNATURE t DATE ) / Z /
BASE FEE FOR OFFICE USE ONLY
RECEIPT#CONSISTENCY REVIEW c CASH/CK# ac r/7
2
TOTAL L. DATE In / /a003
*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