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Home My WebLink AboutBLD2003-00665 0 0 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 #: BLD03-00665 _ ,n, rr,,a, Received Date 10/22/2003 SITE ADDRESS: 160 GOLIATH LN l Issue Date 10/22/2003 PORT LUDLOW, 98365 APPLICANT: LINNEA I JENSEN PHONE: 160 GOLIAH LN PORT LUDLOW WA 983659641 SUBDIVISION: PORT LUDLOW NO 2 AREA 2 Block: Lot: PARCEL NUMBER: 990602101 Section: 9 Township: 28N Range: 01E CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2004 OWNER, LINNEA I JENSEN PHONE: if different: 160 GOLIAH LN PORT LUDLOW WA 983659641 PROJECT DESCRIPTION: 2-120 gal ABOVE GROUND PROPANE TANKS, 2-FIREPLACE INSERTS, GAS PIPING 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 10/22/2004. REQUIRED INSPECTIONS: [ Tank/Line/Appliance: C, J/- 41'O [ '' FinalApprovaL C— //- Y'"D3 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 • BLD03-00665 BUILDING PERMIT APPLIION Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD03-00665 Ah Received Date: 10/22/2003 SITE ADDRESS: 160 GOLIATH LN PORT LUDLOW, 98365 OWNER: LINNEA I JENSEN PHONE: 160 GOLIAH LN PORT LUDLOW WA 983659641 SUBDIVISION: PORT LUDLOW NO 2 AREA 2 Block: Lot: PARCEL NUMBER: 990602101 Section: 9 Township: 28 N Range: 01 E 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 2-120 gal ABOVE GROUND PROPANE TANKS, 2-FIREPLACE INSERTS, GAS PIPING 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 ZAN 10/22/03 60303 Total: $47.00 r. ~ JEFFERSON COUNTY COMM•Y DEVELOPMENT,621 SHERIDAN ST,PORT TO•END WA 98368 PH: (360)379-4450 INSTALLATION PERMIT APPLICATION MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION a?4 /.D i� Underground PROPANE TANK* X Above Ground PROPAN TANK HEAT STOVE HOT WATER TANK WOODSTOVE Y FIREPLACE INSER2 PELLET STOVE COOKING STOVE 7�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): /4 0 6-01_,/,9/ Lc)6'tij /a/- Lf- til--.e..40. ) / Ids-. ZIP 9 di &( 9 DIGIT PARCEL ID NUMBER 9 g Q -- 6, 02 - 1 0 / Legal Description: Subdivision Name Block Lot(s) Section Township North, Range WM APPLICANT /�-/17 h ed.— .//CYf,f Pi,.._J PHONE 3 0/ 042 v MAILING ADDRESS c ZIP PROPERTY OWNER / `_c...,.....! PHONE MAILING ADDRESS ie-- _.. 1 ZIP CONTRACTOR re SUNSHINE PROPANE �� Quality Energy Services Since 1980 PHONE 10853 Rhody Dr.Hadlock,WA 98339 MAILING ADDRESS �/ '� J (360)385-5797 or 683-4010 www.sunshinepropane.com /�P ZIP / STATE LICENSE# ,<�41,5 p 7 Q 77 Vr EXP.DATE ///O(71 FEDERAL I.D.# 1l l 0 7 ! a 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 unty 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 prop y or structure shall be requested and shall occur during regular business hours. 2 APPLICANTS SIGNATURE ye-, DATE i0 / ZLl 0j FOR OFFICE USE ONLY r�9p BASE FEE y1. RECEIPT# hC l7 CONSISTENCY REVIEW CASH/CK# /W-3 TOTAL in , ° DATE l U 12.2.1 03 *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 SITE VISIT REPO.' JOB ADDRESS DATE R-IGa-03 BY.DF1V�. 1,, PHONE Draw a simple plot plan: include property lines and proximity to lines, tanks, wells, driveways, shrubs & trees, exhaust vents, air intake, combustible sources, relevant windows and doors. In Clallam County, include septic. House X Mobile Home Commercial I 0 - ' zoo F'4`,2' Lipu �Qr'—'A r Cps G F,+x lidVI i17N Nw°�� 4>t rays�lL I. A' n-re to' M h OVA o it-A a- fiffinil z 1 { \\\SPC: N. "`.. • . 1140! • 4. INK R.VLW N R01M-1RwVe,Wr.j loweV AADVNO'6 (..14. 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