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HomeMy WebLinkAboutBLD2003-00681 • a 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 #: BLD03-00681 Received Date 10/28/2003 SITE ADDRESS: 430 THEATRE RD Issue Date 10/28/2003 PORT TOWNSEND, 98368 APPLICANT: CHARLES E TRISKO PHONE: SUSAN D TRISKO 430 THEATRE ROAD PORT TOWNSEND WA 98368 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001282019 Section: 28 Township: 30N Range: 01W CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/6/2004 OWNER, CHARLES E TRISKO PHONE: if different: SUSAN D TRISKO 430 THEATRE ROAD PORT TOWNSEND WA 98368 PROJECT DESCRIPTION: PROPANE TANK AND HEATER 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 10/28/2004. REQUIRED INSPECTIONS: [ ] Tank/Line/Appliance: [ ] FinalApproval: 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 JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 1 REFUND REQUEST/POSTING MEMO DATE: oo4 1t- The amount of / 3'7• received from CR0.r I'e-5 r,5 for(case#) 'I D 03 'Ceo(o$ I is to be refunded to: C.F1o.r k S 1('�5 lip -430--hec,71-1-,e A)00-"To wr.�,e,r.ca VJA //11 ads as a result of: Cil rLC_P t PYbpOJ\.2— 'PR.(m Ck— Date di number of original receipt: /O/218/a003 4 (to O aq 3 ast409 -7 REVENUE FUND CODE NO. REVENUE SOURCE NAME AMOUNT 143-000-010 322.10.00 BUILDING PERMIT APPLICATIONS BLD 143-000-010 322.40.20 ROAD APPROACH PERMIT APPLICATIONS RAP 143-000-010 322.40.30 UTILITY PERMIT APPLICATIONS 143-000-010 322.40.80 ADDRESS FEES 911 143-000-010 334.04.20.20 CTED GRANTS • 143-000-010 341.50.00 SALE OF MAPS di PUBLICATIONS PUBS 143-000-010 341.60.00 DUPLICATING SERVICES COP/DUP 143-000-010 345.81.00 SUBDIVISION APPLICATIONS 143-000-010 345.81.10 CAMPER CLUB APPLICATIONS 143-000-010 345.81.20 SHORELINE SUBSTANTIAL DEV.PERMIT APPS 143-000-010 345.81.30 CURRENT USE TAX ASSESSMENT APPLICATIONS 143-000-010 345.81.40 ZONING APPROVAL APPLICATIONS 143-000-010 345.81.50 CRITICAL AREA REVIEW CAR 143-000-010 345.81.60 CONVERSION OPTION HARVEST PLAN COHP 143-000-010 345.83.00 PLAN CHECK FEES 143-000-010 345.89.00 ENVIRONMENTAL REVIEW/SEPA 143-000-010 346.22.30.40 DCD Water Review 143-000-010 359.90.60 SHORELINE VIOLATIONS 143-000-010 359.90.65 BUILDING CODE VIOLATIONS 143-000-010 365.90.40 IFT-HEALTH DEPT FEES 001-250-000 369.90 MISC TREASURER REV-BAD CHECK FEE 127-000-010 346.22.30.10 HEH523 WATER AVAILABILITY FEES H2O 127-000-010 346.22.30.10 HEH54I LIQUID WASTE FEES SEPTIC 127-000-010 346.22.30.10 HEH582 SHORT/LONG PLAT FEES 180-000-010 3224050 RIGHT OF WAY APPLICATIONS 180-000-010 3432010 ROAD FUND 626-000-010 23910 PLNG TRUST ACCT 638-000-110 38900 TREASURE'S SUSPENSE FUND 650-170-030 38600 STATE BLDG CODE FEES 665-003-03036713FIRE DIST#3.MITIGATION FEES 685-049-03030000002900 SCH DIST#49.MITIGATION FEES TOTAL REFUND :77-7. Cp a Oer Authorized person signature: Treasurer's check#: Date: Treasurer's signature: • BUILDING PERMIT APPLIL•ION BLD03-00681 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD03-00681 Received Date: 10/28/2003 SITE ADDRESS: 430 THEATRE RD PORT TOWNSEND, 98368 OWNER: CHARLES E TRISKO PHONE: SUSAN D TRISKO 430 THEATRE ROAD PORT TOWNSEND WA 98368 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001282019 Section: 28 Township: 30 N Range: 01 W CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/6/2004 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP PROPANE TANK AND HEATER INSTALLATION 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: CONST TYPE: GARAGE: SHORELINE: DECK: SETBACK: SEWAGE DISPOSAL: BANK HEIGHT: WATER SYSTEM: PARCEL TAGS: YES NO BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA Exist: Exist: Wetland Prop: Prop: Erosion 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 10/28/03 60293 Total: $47.00 JEFFERSON COUNTY COMMU•DEVELOPMENT.621 SHERIDAN ST.PORT TOWIID WA 98368 PH: (360)379-4450 INSTALLATION PERMIT APPLICATION MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION Underground PROPANE TANK* i.. 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? y' YES ' NO SITE ADDRESS(911#1 Road Name): v 1 P—At 7i7 a2-44 URr ������ I tiff ZIP 9 S b 8 9 DIGIT PARCEL ID NUMBER P U/ ©I 9 Legal Description: Subdivision Name Block Lot(s) Section ' Township North, Range WM APPLICANT C""i/ / f � L(`„1,e?,C PHONE -1 3 S- //tom MAILING ADDRESS `7.3& . 120 7- °d 1,�a� SLvt ZIP "? g36 8 PROPERTY OWNER C-414 % - ?"> PHONE $ a MAILING ADDRESS S ZIP CONTRACTOR C fit. ex PHONE MAILING ADDRESS 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 structure shall be requested and shall occur during regular business hours. APPLICANTS SIGNATURE DATE I / D BASE FEE FOR OFFICE USE ONLY RECEIPT# CONSISTENCY REVIEW CASH/CK# TOTAL DATE / / *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:\HOME1PLNCNTRUNFOBLDGIFORMSUNSTALL.DOC NM*