HomeMy WebLinkAboutBLD2003-00660 11111
BLD03-00660
BUILDING PERMIT APPLICA ON Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00660 Received Date: 10/21/2003
SITE ADDRESS: 13694 AIRPORT CUTOFF RD
PORT TOWNSEND, 98368
OWNER: JEFFERSON CO HIST SOCIETY PHONE:
A N/P PUBLIC BENEFIT CORP
540 WATER STREET
PORT TOWNSEND WA 98368
SUBDIVISION: SETON SHORT PLAT Block: Lot: 1
PARCEL NUMBER: 001282022 Section: 28 Township: 30 N Range: 01 W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI PROPANE TANK INSTALLATION
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 1997 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: # OF STORIES:
OCCUPANCY: 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 By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 PRB 10/21/03 60129
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
5 wwp 00- 4Pyis T",Jc. Sop w % 4- 2,50
Underground PROPANE TANK* Z.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): •13 toCI it 41/161ot Cua_
11 Q
// )/
I s 10 C (,��'` ZIP /CA`�RJ c
9 DIGIT PARCEL ID NUMBER 0 0 ( a a-- --D--
Legal Description:
Subdivision Name Block Lot(s)
Section Township_ North, Range WM
APPLICANT JC`)' 4/1`P t ca.-r -C • PHONE 38S /003
MAILING ADDRESS 5 LI-0 (.)c e-, - fi
0 / • 1 O ZIP � 13C?
PROPERTY OWNER cJ It- CO , /C#L cC. . PHONE
MAILING ADDRESS c-- Q14.Cet-9.7-
ZIP
CONTRACTOR /1.tlYJ�r-� PHONE
MAILING ADDRESS //06)s 3 /2h e 9-f-•" • /1/44 p., ,_ �4-- ZIP (Jp J3 '
STATE LICENSE# �07 7 Q ,O EXP.DATE ii/°.J
FEDERAL I.D.# 9/ /1C)7`t CFS7
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 plicant's pro rty or structure shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE . 1�.-7 -7) Ctr>--
73- J(. DATE /0 / ) / O3
r�OR OFFICE USE ONLY / / Q
BASE FEE �Ov RECEIPT# 0(Z--1
CONSISTENCY REVIEW 6 _ CASH/CK# -t Q/'1 -7
TOTAL Lf1• C DATE w /2 / O,
*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. . �\
.iEIC - V fir`. b
Opermitcenter\forms\bldg forms\install-revised 10-23-02.doc
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JEFFERSON COUNTY DCD
• •
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 #: BLD03-00660 Received Date 10/21/2003
SITE ADDRESS: 1360.) AIRPORT CUTOFF RD Issue Date 10/21/2003
PORT TOWNSEND, 98368
APPLICANT: JEFFERSON CO HIST SOCIETY PHONE:
A N/P PUBLIC BENEFIT CORP
540 WATER STREET
PORT TOWNSEND WA 98368 1
SUBDIVISION: SETON SHORT PLAT Block: Lot:
PARCEL NUMBER: 001282022 Section: 28 Township: 30N Range: 01W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2004
OWNER, JEFFERSON CO HIST SOCIETY PHONE:
if different: A N/P PUBLIC BENEFIT CORP
540 WATER STREET
PORT TOWNSEND WA 98368
PROJECT DESCRIPTION: PROPANE TANK 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 10/21/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[ inalApproval: 1i4- /< oNlr 2/01-0/0/oy
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