HomeMy WebLinkAboutBLD2003-00679 •
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 #: BLD03-00679 Received Date 10/28/2003
SITE ADDRESS: 80 CASCADE PL#120 Issue Date 10/30/2003
PORT LUDLOW, 98365
APPLICANT: RICHARD D JOHNSTON PHONE:
PAULA G JOHNSTON
PO BOX 476
SEABECK WA 983800476
SUBDIVISION: THE ADMIRALTY Block: Lot:
PARCEL NUMBER: 990300130 Section: 9 Township: 28N Range: 01E
CONTRACTOR: FERRELLGAS Enn2ratd µeaV4k 1-6re PHONE: (360)779-7567
646 SO 3RD AVE dot I y S-a,+e b-kwy 3 oS
SEQUIM WA 98382 1�-oolboo, w A 9g383
Contractor's License FERRELP055LH Expires 08/01/2004
Ii'mERA.t$g75P0 /0/2o/2005
OWNER, RICHARD D JOHNSTON PHONE:
if different: PAULA G JOHNSTON
PO BOX 476
SEABECK WA 983800476
PROJECT DESCRIPTION: ABOVE GROUND PROPANE TANK (FERRELLGAS)
FIREPLACE INSERT(EMERALD HEARTH HOME & SPAS)
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 10/30/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Applianc L. //- -�
[ ] FinalApproval: OK -ay- CjD /4Z�D3 /
f
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_B LD_Perm it_Propane.rpt 10/29/19
BLD03-00679
•UILDING PERMIT APPLICA'i I'ON Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00679 Received Date: 10/28/2003
SITE ADDRESS: 80 CASCADE PL#120
I?*- LtA in,of,..�
OWNER: RICHARD D JOHNSTON PHONE:
PAULA G JOHNSTON
PO BOX 476
SEABECK WA 983800476
SUBDIVISION: THE ADMIRALTY Block: Lot:
PARCEL NUMBER: 990300130 Section: 9 Township: 28 N Range: 01 E
CONTRACTOR: FERRELLGAS PHONE: (360)779-7567
646 SO 3RD AVE
SEQUIM WA 98382
Contractor's License FERRELP055LH Expires 08/01/2004
REPRESENTATIVE: PHONE:
rce,t;l 1
e�rn +S( T PROJECT DESCRIPTIOP ABOVE OUND PROPANE TANK AND FIREPLACE INSERT
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:
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
'O 2O Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: /� rp v EE)Propane Tanks/Stoves $47.00 ZAN 10/28/03 60310 /"� �°� �/
Total: $47.00 OCT 3 0 2003
Jefferson County Planning
It& Bui ing Bepartme/'
If alczil
1 SC
JEFFERSON COUNTY COMMUNI•VELOPMENT,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* 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):
CA5CAP (L lze)
70 ZIP
9 DIGIT PARCEL ID NUMBER 9 90 09/
Legal Description:
Subdivision Name Block Lot(s)
�J Section Township North, Range WM
APPLICANT ?L' 1(/1 PHONE 413 7- 7 I Z 1)
MAILING ADDRESS 1". U, 60x- /p j/ 06" y�
611T— LU /L {!/ ZIP 9 g
PROPERTY OWNER j /+- / j �- PHONE
MAILING ADDRESS
ZIP
CONTRACTOR fr-s Lc. : s� S,�iR-' PHONE -2 79 `7`J 4'7
MAILING ADDRESS 2 07 / -/ ci L i j„4,y
GOA 9 ZIP 9e 370
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 Coun 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 ap licant' r erty str ctu sh be re d and shall occur during regular business hours.
APPLICANT'S SIGNATURE V' DATE ,tea /LI
FOR OFFICE USE ONLY
BASE FEE - RECEIPT#
CONSISTENCY REVIEW CASH/CK# / 14S
TOTAL �� DATE C(-' /2-& C✓t
*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 N STALL.DOC
6A5 FR tij 44 S 7 /7 6 6 373 7 Z51
Ri
OCT 2 8 2003
JEFFERSON COUNTY
DEPT. OF COMMUNITY DEVELOPMENT