HomeMy WebLinkAboutBLD2003-00657 •
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 #: BLD03-00657 Received Date 10/20/2003
SITE ADDRESS: 150 N BAY WAY Issue Date 10/20/2003
PORT LUDLOW, 98365
APPLICANT: JEFFREY A LA MAINE PHONE:
CHERYL L LA MAINE
150 N BAY WAY
PORT LUDLOW WA 98365
SUBDIVISION: OAK BAY WATERFRONT TRACTS Block: Lot:
PARCEL NUMBER: 976800014 Section: 29 Township: 29N Range: 01 E
CONTRACTOR: FERRELLGAS PHONE: (360)582-0231
646 SO 3RD AVE
SEQUIM WA 98382
Contractor's License FERRELP055LH Expires 08/01/2004
OWNER, JEFFREY A LA MAINE PHONE:
if different: CHERYL L LA MAINE
150 N BAY WAY
PORT LUDLOW WA 98365
PROJECT DESCRIPTION: ABOVE GROUND PROPANE TANK AND HEAT 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 10/20/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:4k dk // 03 h ���i Sr'&'z 6K //S/!3
� k-z Li. G//`/bf/ /ArrAvztrfie_ am% L, di/ /i fr� 3
[ ] FinalApproval: �1 �ar C /S //U4/a3 eAl
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
• BUILDING PERMIT APPLIC ION B RD03-0065 7
eview Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00657 Received Date: 10/20/2003
SITE ADDRESS: 150 N BAY WAY
PORT LUDLOW, 98365
OWNER: JEFFREY A LA MAINE PHONE:
CHERYL L LA MAINE
150 N BAY WAY
PORT LUDLOW WA 98365
SUBDIVISION: OAK BAY WATERFRONT TRACTS Block: Lot:
PARCEL NUMBER: 976800014 Section: 29 Township: 29 N Range: 01 E
CONTRACTOR: FERRELLGAS PHONE: (360)582-0231
646 SO 3RD AVE
SEQUIM WA 98382
Contractor's License FERRELP055LH Expires 08/01/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP ABOVE GROUND PROPANE TANK AND HEAT STOVE
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION
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 ZAN 10/20/03 60194
Total: $47.00
JEFFERSON COUNTY COMMISY DEVELOPMENT,621 SHERIDAN ST,PORT TO\ND 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/Mobile Home?
YES NO
SITE ADDRESS(911#/Road Name):
rJ 0 /0 2-i,---J z
ZIP
9 DIGIT PARCEL ID NUMBER r 7 c, G C) l
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
j_C'b v/ s i
APPLICANT PHONE PI 360 4,13 9-
MAILING ADDRESS c,' //CV-7 / / .2 k ),°
C'' 'i<C1�1i'cif • ZIP
PROPERTY OWNER PHONE
MAILING ADDRESS j f}4 1'7
ZIP
CONTRACTOR —cc..r ter-L. A77,777e 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 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 applicant's property or structure shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE DATE
r FOR OFFICE USE ONLY
BASE FEE RECEIPT#
CONSISTENCY REVIEW CASH/CK#
TOTAL 7 () DATE / /
*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. MI*
H:\HOME\PLNCNTR\INFOBLDG\FORMS\I NSTALL.DOC