HomeMy WebLinkAboutBLD2003-00675 • •
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 #: BLD03-00675 Received Date 10/27/2003
SITE ADDRESS: 1641 CAMP DISCOVERY RD Issue Date 10/27/2003
QUILCENE, 98376
APPLICANT: RICHARD PATRICELLI PHONE: (425)454-0170
9529 NE 31ST
CLYDEHILL WA 98004-1737
T 10
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 701224009 Section: 22 Township: 27N 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,
if different:
PROJECT DESCRIPTION: GAS PIPING TO GENERATOR
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 10/27/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: £ A5 pi&c -ro CENEp47 2 /7/< // 0/3 fr
[ ] FinalApproval: �, -ccir eAs / /Z1/ 4•
1
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
UILDING PERMIT APPLICAN B Review 111
D0100392
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00675 Received Date: 10/27/2003
SITE ADDRESS: 1641 CAMP DISCOVERY RD
QUILCENE, 98376
OWNER: RICHARD PATRICELLI PHONE: (425)454-0170
9529 NE 31ST
CLYDEHILL WA 98004-1737
SUBDIVISION: Block: Lot: T 10
PARCEL NUMBER: 701224009 Section: 22 Township: 27 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 DESCRIPTION GAS PIPING TO GENERATOR
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
"l Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid Bv: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 ZAN 10/27/03 60137
Total: $47.00
, • JEFFERSON COUNTY COMMUNIT•VELOPMENT,621 SHERIDAN ST,PORT TOWNS 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 INSERTPELLETST— CJ STOVE COOKING STOVE
6 OTHER(Please Specify) , 9S P 1 P /f7 G - [7'eir-) 27,-t--1._,&'`r-
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):
C�4,.//�-�..� !�� ZIP /f 13 7
9 DIGIT PARCEL ID NUMBER 70( 0202. 9 d O,
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
k *
APPLICANT l6 �/¢"/-IQ•�CPLL� /PHONE / ..2`3 • 7 L/f:57 j Z3
MAILING ADDRESS /��9 �V L J/`rr y/ Jr
ILA �yde Al/L-- / !�Y /7 . ZIP 90Q
40 Y
PROPERTY OWNER 0--7...r PHONE
MAILING ADDRESS
•
SUNSHINE PROPANE
CONTRACTOR Quality Energy Services Since 1980
10853 Rhody Dr. Hadlock,WA 98339
MAILING ADDRESS (360)385-5797 or 683-4010
www.sunshinepropane.com
•
STATE LICENSE# S'-( I/) S ' /' * O 7 7 Q / EXP.DATE 2 G/ O V
FEDERAL I.D.# eii / O7/c P 6 7
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 ounty 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 prope or structure shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE t' a DATE ./ / ] bj
--7 a) FOR OFFICE USE ONLY
BASE FEE ii /r RECEIPT# /J j C) /
CONSISTENCY REVIEW -- - CASH/CK# %/
TOTAL 4' 1 f - DATE ID '7/ 03
*Underground Propane Tank applications require additional information to be submitted. i L.--- • , OVER - R -.__
Please contact our office at 360-379-4450 if the back of this application is blank. b: U -\s 1
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JEFFERSON COUNTY
DEPT. OF COMMUNITY DEVELOPMENT
A - • SITE VISIT REPOR.
JOB l R 1(_-�: L-k-- DATE
ADDRESS •- . P allgert p BY
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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.
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, OCT 2 7 2003 .-
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