HomeMy WebLinkAboutBLD2003-00697 •► • .� .
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 #: BLD03-00697 Received Date 11/7/2003
SITE ADDRESS: 24 SPARROW CT Issue Date 11/7/2003
PORT LUDLOW, 98365
APPLICANT: FRANK R MURR PHONE:
JUDITH L MURR
24 SPARROW CT
PORT LUDLOW WA 983659644 14
SUBDIVISION: PORT LUDLOW NO. 4 Block: Lot:
PARCEL NUMBER: 990500014 Section: 17 Township: 28N Range: 01 E
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2004
OWNER, FRANK R MURR PHONE:
if different: JUDITH L MURR
24 SPARROW CT
PORT LUDLOW WA 983659644
PROJECT DESCRIPTION: PROPANE TANK, PIPING AND FIREPLACE
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 11/7/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
r
[ ] FinalApproval: (✓ W comb 0/- (Y-o-s
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
•
BUILDING PERMIT APPLI ION BLDOe 00697
w Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00697 Received Date: 11/7/2003
SITE ADDRESS: 24 SPARROW CT
PORT LUDLOW, 98365
OWNER: FRANK R MURR PHONE:
JUDITH L MURR
24 SPARROW CT
PORT LUDLOW WA 983659644
SUBDIVISION: PORT LUDLOW NO. 4 Block: Lot: 14
PARCEL NUMBER: 990500014 Section: 17 Township: 28 N Range: 01 E
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 DESCRIPTIOI` PROPANE TANK, PIPING AND FIREPLACE
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 67:0
BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA
Exist: Exist: Wetland *1 O Erosion k
Prop: Prop: Seismic ND Streams N D
Total: Total: Flood Way NJ 0 Floodplain t
Routing Date: F&W �T`i� Landslide N 0
Shoreline I Aquifer
Forest: Commercial Off Rural �`' A
Type Amount Paid Bv: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 PRB 11/07/03 60360
Total: $47.00
JEFFERSON COUNTY COMMY DEVELOPMENT,621 SHERIDAN ST,PORT TO•ND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION 9 9
Underground PROPANE TANK* Above Ground PROPANE TANK HEAT STOVE HOT WATER TANK
WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE
OTHER(Please Specify) f-1 ta-e— F-L' %‘—,
Is this appliance(htg ' ove, hot water tank,furnace,etc.)to be installed in a Manufactured/Mobile Home?
YES NO
SITE ADDRESS(911#/Road Name): 0
2 cf 4, ic--r-ccrzJ et
P/ - Lbi3Otic)W ZIP / Cl3 6
9 DIGIT PARCEL ID NUMBER (i '/ 0 Soo 0(4
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range ?? WM
,4.APPLICANT ra ,',Liz_ PHONE '/.7 7-^1 c33
MAILING ADDRESS , -y Jpar r-o Ci-
e I • 1_/.C. -to L-J `4 ZIP
PROPERTY OWNER E'�`"q/^�
vv0- �"� -{ PHONE
MAILING ADDRESS ?, Z
ZIP
CONTRACTOR �� SUNSHINE PROPANE PHONE
ti Quality Energy Services Since 1980
MAILING ADDRESS r , 10853 Rhody Dr.Hadlock,WA 98339
V, 'S l (360)385-5797 or 683-4010
www.sunshinepropane.com ZIP
STATE LICENSE# r5t..4k)SOP'( 0 77 4 10 EXP.DATE 1/l ZY
FEDERAL I.D.# q/ "' / 0 7 1 sr3 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 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 d 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 str ture shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE -- `--.._ DATE if / 0S/ C
i ' FOR OFFICE USE ONLY /_A�! b
BASE FEE -147-Ob RECEIPT# W t0
CONSISTENCY REVIEW Z3 -Sb CASH/CK# q"[ZD
TOTAL 76'5-0 DATE (( / 1 / .03
*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:\permitcenter\forms\bldg forms\install-revised 10-23-02.doc
NOV 7 2003
JEFFERSON COUNTY DCD
0 SITE VISIT REPORT
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PROJECT PLANNER:
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JEFFERSON COUNTY DCD