HomeMy WebLinkAboutBLD2003-00683 0 41li
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 #: BLD03-00683 Received Date 10/30/2003
SITE ADDRESS: 90 W SWANEY ST Issue Date 10/30/2003
PORT HADLOCK, 98339
APPLICANT: DAVID M MAXWELL PHONE: (360) 765-3750
HAZEL E MAXWELL
PO BOX 51
PORT HADLOCK WA 98339 29-31
SUBDIVISION: IRONDALE Block: 49 Lot:
PARCEL NUMBER: 961804912 Section: 34 Township: 30N Range: 01W
CONTRACTOR: FERRELLGAS PHONE: (360)582-0231
646 SO 3RD AVE
SEQUIM WA 98382
Contractor's License FERRELP055LH Expires 08/01/2004
OWNER, DAVID M MAXWELL PHONE: (360) 765-3750
if different: HAZEL E MAXWELL
PO BOX 51
PORT HADLOCK WA 98339
PROJECT DESCRIPTION: PROPANE TANK 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 10/30/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: 114r-1L//G.i-„v,r o/.Q� i i.-A6-03
[ FinalApproval:-i71,4i 9,"„4 k1,,r
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
UILDING PERMIT APPLICAN BLD03-00435
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00683 Received Date: 10/30/2003
SITE ADDRESS: 90 W SWANEY ST
PORT HADLOCK, 98339
OWNER: DAVID M MAXWELL PHONE: (360) 765-3750
HAZEL E MAXWELL
PO BOX 51
PORT HADLOCK WA 98339
SUBDIVISION: IRONDALE Block: 49 Lot: 29-31
PARCEL NUMBER: 961804912 Section: 34 Township: 30 N Range: 01 W
CONTRACTOR: FERRELLGAS PHONE: (360)582-0231
646 SO 3RD AVE
SEQUIM WA 98382
Contractor's License FERRELP055LH Expires 08/01/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI PROPANE TANK 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:
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
1 10.3 Shoreline Aquifer
IIII Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 ZAN 10/30/03 60312
Total: $47.00
JEFFERSON COUNTY COMMUNIOEVELOPMENT,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* K 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):
Z�d � f fr' o j_o ck ,p 6,1i/9 ZIP 3
9 DIGIT PARCEL ID NUMBER god go
Legal Description:
Subdivision Name jr, 44. L)/ - Block 47 Lot(s) �- 3/
Section 3 44 Township 30 North, Range / W WM
APPLICANT >N A Z6 L E.• H V I D Ak. MAX ui E L L PHONE 360 7,S 3 750
MAILING ADDRESS f c 3v X .. 'i f
ZIP 6037-4_ `/
PROPERTY OWNER ZEL E, t D a V i D M . /17(Y4k. X 14..E L fin. PHONE
MAILING ADDRESS 5 A 04 7= AS A- 6 a' E
ZIP
CONTRACTOR /'/(ELL &-A5 PHONE ?(D°-.- 63 . ��
MAILING ADDRESS 6 LIE 6, 50 e.) /E I///HE'D 14 J 6
&_; LLlfK , fl ZIP /g 3 2- 37 ?6
STATE LICENSE# / / l E L P 0 5 5 L H 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 thpapplicant's property} or structure shall be requested andannd shall occur during regular business hours.
APPLICANTS SIGNATURE }V �r //�-��L Gv-C � �*-C� DATE /0/ 1 / 6-2
FOR OFFICE USE ONLY
BASE FEE 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. INIM*
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