HomeMy WebLinkAboutBLD2003-00673 OUILDING PERMIT APPLICA•N BL v Reviewiew T Ty673
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Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00673 Received Date: 10/24/2003
SITE ADDRESS: 5784 CENTER RD
CHIMACUM, 98325
OWNER: BARBARA A VODDER PHONE:
5784 CENTER RD
CHIMACUM WA 983259716
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 801091001 Section: 9 Township: 28 N Range: 01 W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTP198306 Expires 09/26/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr ABOVE GROUND PROPANE TANK AND HEAT STOVE
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
/V (/ 0 Shoreline Aquifer
/ Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 ZAN 10/24/03 60308
Total: $47.00
JEFFERSON COUNTY COMMUNI•EVELOPMENT,621 SHERIDAN ST,PORT TOWN.WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* X Above Ground PROPANE TANK X 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):
CJ7LC�yy7�" ZIP / O -?`'
9 DIGIT PARCEL ID NUMBER e �/ t 76 0 O
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT 7 PHONF�3 o4-
� yy
MAILING ADDRESS 0 4l Jedd
��/ ZIP
PROPERTY OWNER L8a v-4 1�Lro'aril PHONE �c -4/s'6o.2
MAILING ADDRESS 5-7 0 G�
ZIP ! c11:2j
CONTRACTOR }-ld � ,-� / PHONE 7
MAILING ADDRESS /i O rJ ��A0� ny7 �i�,J`Q 4
ars3/ 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 tructureshallll be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE c /J G �Q, f! l/ 'v DATE //.� / Ci
o i �R OFFICE USE ONLY
BASE FEE `-} • RECEIPT# (00 3t�g
CONSISTENCY REVIEW CASH/CK# 13 3.5/y
TOTAL - 15:1 DATE ( ° /2-`6 03
*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\PLN CNTR\I N FOBLDG\FORMS\I NSTALL.DOC
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 #: BLD03-00673 Received Date 10/24/2003
SITE ADDRESS: 5784 CENTER RD Issue Date 10/24/2003
CHIMACUM, 98325
APPLICANT: BARBARA A VODDER PHONE:
5784 CENTER RD
CHIMACUM WA 983259716
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 801091001 Bre-0" Section: 9 Township: 28N Range: 01W
CONTRACTOR: MOUNTAIN PROPANE Airx41Weg! Fitt,late PHONE: (360)385-6883
/ � / 265 CHIMACUM RD 40,Div Akcn W
lot `� PORT HADLOCK WA 98339 we_vv er , t int,
Contractor's License MOUNTP198306 Expires 09/26/404
NcR 14F&- 44K6 5/7A01311
OWNER, BARBARA A VODDER PHONE:
if different: 5784 CENTER RD
CHIMACUM WA 983259716
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 10/24/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: K ? t-/,u s '3a P.2 ,— / /-.5"--03
[ ] FinalApproval: ' 5• (_p_R.- 7d'
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