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Home My WebLink AboutBLD2003-00692 S 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 #: BLD03-00692 Received Date 11/6/2003 SITE ADDRESS: 581 S BAY WAY Issue Date 11/7/2003 PORT LUDLOW, 98365 APPLICANT: JERALD J ADAMS PHONE: ELFRIEDE ADAMS, TRUSTEES 581 S BAY WAY PORT LUDLOW WA 983659466 SUBDIVISION: Block: Lot: PARCEL NUMBER: 921294007 Section: 29 Township: 29N Range: 01E CONTRACTOR: FERRELLGAS PHONE: (360)582-0231 646 SO 3RD AVE SEQUIM WA 98382 Contractor's License FERRELP055LH Expires 08/01/2004 OWNER, JERALD J ADAMS PHONE: if different: ELFRIEDE ADAMS, TRUSTEES 581 S BAY WAY PORT LUDLOW WA 983659466 PROJECT DESCRIPTION: U/G Propane 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 11/07/2004. REQUIRED INSPECTIONS: [ ] Tank/Line/Appliance: ed CED HBGvE 6patko C;gAo& 4,7$ -rANK !l/ G3 [ ] FinalApproval: /jK 1. l 03 4 OK or PU f// llj 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 10/29/19f -r.- BLD03-00692 UILDING PERMIT APPLIC . ON Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD03-00692 Received Date: 11/6/2003 SITE ADDRESS: 581 S BAY WAY PORT LUDLOW, 98365 OWNER: JERALD J ADAMS PHONE: ELFRIEDE ADAMS, TRUSTEES 581 S BAY WAY PORT LUDLOW WA 983659466 SUBDIVISION: Block: Lot: PARCEL NUMBER: 921294007 Section: 29 Township: 29 N Range: 01 E CONTRACTOR: FERRELLGAS PHONE: (360)582-0231 646 SO 3RD AVE SEQUIM WA 98382 Contractor's License FERRELP055LH Expires 08/01/2004 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr U/G Propane tank 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 00 Erosion NO Prop: Prop: Seismic Streams Total: Total: Flood Way Floodplain 4O Routing Date: F&W Landslide Shoreline 6 Aquifer Forest: Comm cial Rural Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $47.00 CJZ 11/06/03 60323 Total: $47.00 JEFFERSON COUNTY COMMUNIOEVELOPMENT,621 SHERIDAN ST,PORT TOWN WA 98368 PH: (360)379-4450 INSTALLATION PERMIT APPLICATION �_ t( ' ^`fir` E 7 MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION -�_______ . , / ►I (f Underground PROPANE TANK* Above Ground PROPANE TANK* HEAT STOVE AT K �HO�`I 6 �3 1 WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE OTHER(Please Specify) p JEFFERSON COUNTY E T OF COfAillUfalT'��EVi: P T 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): 5(2 l S . ;aa' (` )rs j i 1912 T. Lcal n c,0 i (A)A ZIP q�3 6 r 9 DIGIT PARCEL ID NUMBER "Iii,1 a.`71 20 7 Legal Description: Subdivision Name Block c� Lot(s) Section 5 (k°1 Township's AI North, Range )� 1_ (5_ WM APPLICANT VL,U ()CI INI'n S PHONE 360- y,37-// i( MAILING ADDRESS i-.' I S• ?t Wv9+,1-j (�} 9012 A" i^v g\\91,0, (AA- ZIP 4 i 3&J-- PROPERTY OWNER eeIg1"h 01,11,s PHONE 6o 4 13 7_ if bl1s MAILING ADDRESS 5 A{41'Q ZIP CONTRACTOR 1-2ec I' Y-I S PHONE MAILING ADDRESS S ;e,1 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 n1t,t 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 4 e applicant's prope ^r�strructure s be requested and shall occur during regular business hours. APPLICANTS SIGNATURE *` a_ �y��v uVl DATE /I / / o3 v FOR OFFICE USE ONLY BASE FEE $47.00 RECEIPT# CONSISTENCY REVIEW (93 CASH/CK# i TOTAL I a:, O DATE // / '6 * Propane Tank applications require additional information to be submitted. Please contact our office at 360-379-4450 if the back of this application is blank. OVER + 4 4 G:\PermitCenter\FORMS\BLDG FORMS\ install-revised 10-30-03.DOC 113UILDING PERMIT APPLICASN BLD03-00692 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD03-00692 Received Date: 11/6/2003 SITE ADDRESS: 581 S BAY WAY PORT LUDLOW, 98365 OWNER: JERALD J ADAMS PHONE: ELFRIEDE ADAMS, TRUSTEES 581 S BAY WAY PORT LUDLOW WA 983659466 SUBDIVISION: Block: Lot: PARCEL NUMBER: 921294007 Section: 29 Township: 29 N Range: 01 E CONTRACTOR: FERRELLGAS PHONE: (360)582-0231 646 SO 3RD AVE SEQUIM WA 98382 Contractor's License FERRELP055LH Expires 08/01/2004 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP U/G Propane 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: F&W Landslide Shoreline Aquifer Forest: Commercial Rural Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $47.00 CJZ 11/06/03 60323 Total: $47.00 JEFFERSON COUNTY COMMUODEVELOPMENT,621 SHERIDAN ST,PORT TOW1DID WA 98368 PH_(360)379-4450 INSTALLATION PERMIT APPLICATION 1 I.[ i tt if � MARK AL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION -_ Underground PROPANE TANK* Above Ground PROPANE TANK* HEAT STOVE i AT VK $ a WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE �. OTHER(Please Specify) nEPT OP Cr212 SON COUNTY -_.��_..._. � t-�!UFIIT'Y.`�� rr ,,ra�FN 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): TORT 4.tAA'nLt) (.t) ZIP Qj36r 9 DIGIT PARCEL ID NUMBER "fd, f1 LC,L( 00-7 Legal Description: Subdivision Name Block Lot(s) Section 5 Oke3? Township j A% North, Range ? 1 t- WM APPLICANT -Jc i't i\L O ()(Y AWI S PHONE 3 6 U- W 31-// 'L r MAILING ADDRESS -C 4 I S• tJ 14� (� Coat i,tA4 �WJ) WA- ZIP b 3 � iJ PROPERTY OWNER A lelvn PHONE ?U r 7 l �-t MAILING ADDRESS Cj Awl' ZIP CONTRACTOR re4ee1I 5 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 ri t 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 e applicant's props r structure s 1 be requested and shall occur during regular business hours. APPLICANTS SIGNATURE DATE 'j / 6 / Q3 FOR OFFICE USE ONLY BASE FEE `1 $47.00 RECEIPT# CONSISTENCY REVIEW a3 CASH/CK# 4 TOTAL r 1 V,5-0 DATE // / ? Z) * I Propane Tank applications require additional information to be submitted. Please contact our office at 360-379-4450 if the back of this application is blank. OVER 4 4 4 G:\PermitCenter\FORMS\BLDG FORMS\ install-revised 10-30-03.DOC 0 U o l C �S rtu L. < J IA— Q LL Q IL .'- ) 0 1 0. -._ _ .. -,r J W a ¢ r ` , d O � J0 .� ,,, _„b � Ibo � a - a ' . > L� 1 a !7- • i, I Fr)_ I`11 j1 • C o CC3 I^ i S4,, . ` p W z 1 I 4 V 0 - U N a Intl s<Ai rea w a W r ` 0 1-- 3 V. s m I it � w w ,P Z z w Q < . LLI Cr I T) of ff V r _2 2— � . 4 I_" 1 ! (Si ut ";;, v / W.•••••••aresna.mr. ! VO 1, Q 1 i . n I -�1 J r ./ II _ � I 1n- w ow 0) , , -. '3- 1 Uo ? a < -c� Q 3 � � C C3 o ,: cs--) ,%,._„ k.--1 •..� c f r` 1,1-1 3 0 L/t O P 121 55i `n gat bVM rilb9