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Home My WebLink AboutBLD2003-00690 410 III 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#: BLD03-00690 Received Date 11/5/2003 SITE ADDRESS: 10733 RHODY DR Issue Date 11/5/2003 PORT HADLOCK, 98339 APPLICANT: LAWRENCE R JOHNSON PHONE: 8265 FLAGLER RD NORDLAND WA 983589524 1-30 SUBDIVISION: CHALMER'S 2ND ADDITION Block: 34 Lot: PARCEL NUMBER: 942903401 Section: 3 Township: 29N 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, LAWRENCE R JOHNSON PHONE: if different: 8265 FLAGLER RD NORDLAND WA 983589524 PROJECT DESCRIPTION: GAS PIPE AND RELOCATE EXISTING AG TANK 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 11/5/2004. REQUIRED INSPECTIONS: [ ] Tank/Line/Appliance: 'l/(,.�t,JrS /_ ( 1 -b-03 4-0?+.1) G [ ] FinalApprova e- //-4,2-03 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 APPLICATL BLD03-00690 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD03-00690 Received Date: 11/5/2003 SITE ADDRESS: 10733 RHODY DR PORT HADLOCK, 98339 OWNER: LAWRENCE R JOHNSON PHONE: 8265 FLAGLER RD NORDLAND WA 983589524 SUBDIVISION: CHALMER'S 2ND ADDITION Block: 34 Lot: 1-30 PARCEL NUMBER: 942903401 Section: 3 Township: 29 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 DESCRIPTIOP GAS PIPE AND RELOCATE EXISTING AG TANK 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: 0 03 F&W ' . Landslide j// Shoreline Aquifer ��(i C Forest: Commercial Rural Type Amount Paid Bv: Date: Receipt: Approved/Date Propane Tanks/Stoves $0.00 PRB 11/05/03 Total: $0.00 Nov 05 03 02: 06p • • p. 2 JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST.PORT TOWNSEND 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 r- /16- OTHER(Please Specify) D ( 3 zul-07_4 Is this appliance(htgstove, h water tank,furnace, f J nace,etc.)to be installed in a Manufactured/Mobile Home? YES NO SITE ADDRESS(911#I Road Name): ard - Gj? - ZIP ( 9 DIGIT PARCEL ID NUMBER ` ` 7a 3 �o l Legal Description: Subdivision Name Block Lot(s) Section Township North, Range WM APPLICANT .,pp �- t../J 0�.�, PHONE MAILING ADDRESS fi/r/ 0 3 Sy 7 ZIP ff el 2-r PROPERTY OWNER 3a-eK.�-�] PHONE MAILING ADDRESS I/ f� SUNSHINE PROPANE ZIP CONTRACTOR 14 Quality Energy Services Since 1980 PHONE 10853 Fihody Dr. Hadlock,WA 98339 MAILING ADDRESS .. .� (360)385-5797 or 683-4010 .www.sunshinepropane.com • � ZIP } STATE LICENSE# S u kl S P ' 07 7 Q P EXP.DATE !?/b S/ FEDERAL I.D.# - /a`J 4 es-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 attorneys 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 Cou 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 appli ants property o tructure shall be requested and shall occur during regular business hours. J APPLICANTS SIGNATURE DATE l/ I \Ir /•• �tFOR OFFICE USE ONLY 03 54 BASE FEE RECEIPT# CONSISTENCY REVIEW ] 1 Jc`) CASHICK# cittiq TOTAL St7 DATE t / / d/ *Underground Propane Tank applications require additional information to be submitted. 0 V E R Please contact our office at 360-379-4450 if the back of this application is blank. g;lpermltcenterlformslWdg formslinstall-revised 70-23-02.doC ,` \\', NOV - 5 2003 1s rt-r, f` P• 3 Nov 05 03 02: 06p • 0 SITE VISIT REPORT JOB i -•:%:/,- -, .-:.;4';,./..i./,-.:.-'''. -? . :, -4( '-',••;'„, • DATE „._______,2!.z.____- _ , (t ‘e..._ ... .---- _ PHONE____________ 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. In Clallam County, include septic. House Mobile Home Commercial ' APPROVED SITE PLAN ; NOV 5 2003 IT_ I 4- i JEI/FERSON .1uNTy S., DEPT.OF C4IMU la..% VELOPMEW I SIGNATURE;/V M 1 i I i" I A•;':-,-,1 t 4:61-'-; 1----1 -4 . .-------tri , Li ( / ey C-Q11- 3----- - - Z--T' -JD i -1----- ---,N- -; , .1 Eh'../.:f7t,';•1-:- 10i ;f4 ; -- , r ' i . 1 , 4 -- ,„ 4, 4,71.4 Ir ".:',.; p J , //Oa' C- ',/-)7d21' /( NOV - "/". ",:f Z</e;- /-.C..ce rAvei ; e157,-- AA -,754 , i ''''I, GOUNTY ,- • , - '; ,••• i ' 5 2003 ?t,,,,,,f,, Description: