HomeMy WebLinkAboutBLD2003-00643 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 #: BLD03-00643 Received Date 10/13/2003
SITE ADDRESS: 41 LYLUS LN Issue Date 10/13/2003
PORT HADLOCK, 98339
APPLICANT: DONALD L MYERS PHONE:
CRYSTAL D MYERS
PO BOX 1947
PORT TOWNSEND WA 98368
SUBDIVISION: MELWOOD TERRACE Block: Lot:
PARCEL NUMBER: 972000004 Section: 1 Township: 29N Range: 01W
CONTRACTOR: SUBURBAN PROPANE PHONE: 385-5096
P 0 BOX 989
PORT TOWNSEND WA 98368
Contractor's License SUBURPL044DA Expires 03/12/2005
OWNER, DONALD L MYERS PHONE:
if different: CRYSTAL D MYERS
PO BOX 1947
PORT TOWNSEND WA 98368
PROJECT DESCRIPTION: No MLA Req'd - Propane Tank& Heating 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 10/13/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: 4(4-/e4)(e/66d /4/ 1
[ ] FinalApproval: 634,' it r /a/z�/Q3 L6?
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.
41113UILDING PERMIT APPLICA ON BL Review view T Ty643
ype:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00643 Received Date: 10/13/2003
SITE ADDRESS: 41 LYLUS LN
PORT HADLOCK, 98339
OWNER: DONALD L MYERS PHONE:
CRYSTAL D MYERS
PO BOX 1W 2a. g6337
PORT TOWNSEND WA•9&36'8
SUBDIVISION: MELWOOD TERRACE Block: Lot:
PARCEL NUMBER: 972000004 Section: 1 Township: 29 N Range: 01 W
CONTRACTOR: SUBURBAN PROPANE PHONE: 385-5096
P 0 BOX 989
PORT TOWNSEND WA 98368
Contractor's License SUBURPL044DA Expires 03/12/2005
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION No MLA Req'd - Propane Tank & Heating Stove
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:
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 CJZ 10/13/03 60238
Total: $47.00
JEFFERSON COUNTY COMMUt EVELOPMENT,621 SHERIDAN ST,PORT TOW NSE /A 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* ` Above Ground PROPANE TANK X 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 Horn ?,
_ YES C NO
SITE ADDRESS(911#/Road Name):
---- / --- yL Gas � p
R! T/�}�� 1��`.k ZIP /j O 3 39
9 DIGIT PARCEL ID NUMBER 1 1 OO( 9
Legal Description:
Subdivision Name 1Y1 d,LLI CSC,® TC-:iz R A CE Block Lot(s)
Section _Township North, Range WM
APPLICANT t)tt M/G e S ii PHONE 3 7 9 - j/sCoY
MAILING ADDRESS ? Q E • x _ 1--,�C3 l2CC� (.V A ZIP 78 33c I
__�PROPERTY OWNER c_ tit Yl PHONE —
MAILING ADDRESS
ZIP
CONTRACTOR SG(.13 it KA AI R DP A N F 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 attorneys 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 e . to Je =rson 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'=. •• or structure shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE i` DATE /0 / /G) / 0_3
BASE FEE '� ._J�?R OFFICE USE ONLY RECEIPT# (Wr 3
CONSISTENCY REVIEW CASH/CK#
TOTAL GI, DATE /C) /!n l
`Underground Propane Tank applications require additional Information to be submitted. OVER
Please contact our office at 360-379-4450 if the back of this application is blank. 1111111111111
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