HomeMy WebLinkAboutBLD2003-00652 ,
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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 #: BLD03-00652 Received Date 10/16/2003
SITE ADDRESS: 212 FIR CIR Issue Date 10/16/2003
PORT HADLOCK, 98339
APPLICANT: DOMINIC A VIGIL PHONE:
SANDRA M COCA
212 FIR CIR
PORT HADLOCK WA 983399597 16
SUBDIVISION: BISHOP ACRES Block: Lot:
PARCEL NUMBER: 932300016 Section: 2 Township: 29N Range: 01W
CONTRACTOR: FERRELLGAS PHONE: (360)582-0231
646 SO 3RD AVE
SEQUIM WA 98382
Contractor's License FERRELP055LH Expires 08/01/2004
OWNER, DOMINIC A VIGIL PHONE:
if different: SANDRA M COCA
212 FIR CIR
PORT HADLOCK WA 983399597
PROJECT DESCRIPTION: Above 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 10/16/2004.
REQUIRED INSPECTIONS:
[ ] C3DTanAppliance: Of J: T/ iL5C_i 0 ,2,1-0 3
[ ] FinalApproval: (e)--2-4-v1
v
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=.
n603-00652
UILDING PERMIT APPLICN Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00652 Received Date: 10/16/2003
SITE ADDRESS: 212 FIR CIR
PORT HADLOCK, 98339
OWNER: DOMINIC A VIGIL PHONE:
SANDRA M COCA
212 FIR CIR
PORT HADLOCK WA 983399597
SUBDIVISION: BISHOP ACRES Block: Lot: 16
PARCEL NUMBER: 932300016 Section: 2 Township: 29 N Range: 01 W
CONTRACTOR: FERRELLGAS PHONE: (360)582-0231
646 SO 3RD AVE
SEQUIM WA 98382
Contractor's License FERRELP055LH Expires 08/01/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION Above 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 Bv: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 CJZ 10/16/03 60246
Total: $47.00
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JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNSEND 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/Moble Home?
YES to.,%N0
SITE ADDRESS(911#/Road Name):
Po 1-14riIaC k ZIP l O33 7
9 DIGIT PARCEL ID NUMBER 9,', 6/1.7C%/(s,
•
Legal Description: /;
Subdivision Name � i 1jJ1 op L{ C? Y''c Block Lot(s) /(1�
Section / Township North, Range WM
APPLICANT ScVtdN PHONE 3 79 c.9 Oil s-
MAILING ADDRESS a la C' 1i�c1`P,
Pc,r 14c,ct ( or- k ZIP 9
PROPERTY OWNER SG.nYIE PHONE
MAILING ADDRESS
ZIP
CONTRACTOR Ferrel 1�..e'cs PHONE C//D j��y
3 9oc;)
MAILING ADDRESS 6 y6, CjR 3"/ C�
7 P L1 I llm ZIP l 3 37%
STATE LICENSE# 't c( °j 955S L r/ EXP.DATE b h 4 e
FEDERAL I.D.# g r>eo ( S l
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 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 appli nt's propertyty or structure shall
shall bbe rr nested and shall occur during regular business hours.
APPLICANTS SIGNATURE �tiyir ,--/��L DATE Jr) / l / L?.
,,'_ OROFFICE USE ONLY
BASE FEE I . • �
RECEIPT#
,
CONSISTENCY REVIEW CA
r SHlCK#
TOTAL•
DATE lo !1(�, H
*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.
H:\HOM E\PLNC NTR\I N FO BLDG\FORMS\INSTALL.DOC