HomeMy WebLinkAboutBLD2003-00645 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 #: BLD03-00645 Received Date 10/13/2003
SITE ADDRESS: 60 GRENVILLE CT Issue Date 10/13/2003
PORT TOWNSEND, 98368
APPLICANT: JONATHAN N SKEETERS PHONE:
NOVA M SKEETERS
60 GRENVILLE CT
PORT TOWNSEND WA 983689525
SUBDIVISION: KALA POINT#6 Block: Lot:
PARCEL NUMBER: 965000193 Section: 27 Township: 30N Range: 01W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPI983O6 Expires 9/26/2004
OWNER, JONATHAN N SKEETERS PHONE:
if different: NOVA M SKEETERS
60 GRENVILLE CT
PORT TOWNSEND WA 983689525
PROJECT DESCRIPTION: PROPANE TANK AND HEAT STOVE INSTALLATION
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 C— /o /(�_fl3
[ ] FinalApproval: /62--/(-03
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
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06
BUILDING PERMIT APPLICATION B RDOe Ow yppe 5
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00645 Received Date: 10/13/2003
SITE ADDRESS: 60 GRENVILLE CT
PORT TOWNSEND, 98368
OWNER: JONATHAN N SKEETERS PHONE:
NOVA M SKEETERS
60 GRENVILLE CT
PORT TOWNSEND WA 983689525
SUBDIVISION: KALA POINT#6 Block: Lot:
PARCEL NUMBER: 965000193 Section: 27 Township: 30 N Range: 01 W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPI98306 Expires 9/26/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr PROPANE TANK AND HEAT STOVE INSTALLATION
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
101
t3 Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 PRB 10/13/03 60262
Total: $47.00
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
Underground PROPANE TANK* VOT 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 1 NO
SITE ADDRESS(911#/Road Name):
Co &ft& ✓/ /)e G7,
/Dort s-e r1 ZIP ] GCS 3 6 z5
9 DIGIT PARCEL ID NUMBER '96✓ aOa —143
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT Mountain Propane PHONE 3SS5_6���
265 Chimacum Rd.
MAILING ADDRESS Port Hadlock,WA saln9
ZIP
PROPERTY OWNER Tay► 5 K ero f ecS / PHONE ,3�SS
MAILING ADDRESS 60 6Ylj491 v,fie c-/
1'o a-t 7 wrJ 5 z°i o/ ZIP 9 'g36 c
CONTRACTOR Mountain Propane PHONE 3 6 S
265 Chimacum Rd.
MAILING ADDRESS Port Hadlook,WA 4$339
n � p ZIP
STATE LICENSE# ' V/ 0 Lj /]/T r /S R06 EXP.DATE 9 0•1--6 -O
FEDERAL I.D.# N) - A0.5-56 5:5-
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 appl' nt's property or structure shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE I� w- DATE it) / /-3 / 03
FOR OFFICE USE ONLY
BASE FEE ( (..O RECEIPT# 60 7-632-
CONSISTENCY REVIEW CASH/CK# 511--.
TOTAL if?'CO DATE r!E / i5/ D 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.
g:\permitcenter\forms\bldg forms\install-revised 10-23-02.doc