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Home My WebLink AboutBLD2003-00704 °BUILDING PERMIT APPLIOP BLD03-00704 CION Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD03-00704 Received Date: 11/12/2003 SITE ADDRESS: 636 MONTGOMERY LN PORT LUDLOW, 98365 OWNER: JEANNE KERALLAH PHONE: (360) 437-8134 636 MONTGOMERY LN PORT LUDLOW WA 98365-9618 SUBDIVISION: PORT LUDLOW NO 1 AREA 2 Block: 57 Lot: PARCEL NUMBER: 990400257 Section: 9 Township: 28 N Range: 01 E 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 DESCRIPTION ABOVE GROUND PROPANE TANK TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 1997 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: 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 Shoreline Aquifer Forest: Commercial Rural Type Amount Paid By: Date: Receipt: Approved/Date Permit $47.00 KAS 11/12/03 60149 APPROVED Total: $47.00 NOV 1 2 2003 Jefferson County Planning & Building Department As d r 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 #: BLD03-00704 Received Date 11/12/2003 SITE ADDRESS: 636 MONTGOMERY LN Issue Date 11/12/2003 PORT LUDLOW, 98365 APPLICANT: JEANNE KERALLAH PHONE: (360)437-8134 636 MONTGOMERY LN PORT LUDLOW WA 98365-9618 57 SUBDIVISION: PORT LUDLOW NO 1 AREA 2 Block: Lot: PARCEL NUMBER: 990400257 Section: 9 Township: 28N Range: 01 E 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, JEANNE KERALLAH PHONE: (360)437-8134 if different: 636 MONTGOMERY LN PORT LUDLOW WA 98365-9618 PROJECT DESCRIPTION: ABOVE GROUND PROPANE TANK (5A2/7CR "ekT 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 11/12/2004. REQUIRED INSPECTIONS: [ ] Tank/Line/Appliance: [ ] FinalApproval: � .. er- .- ham,( 6V/a,`i cil 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 COMMU•DEVELOPMENT,621 SHERIDAN ST,PORT TOWIJD 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 TANja •(* P WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE �.®�` OTHER(Please Specify) r, \ Is this appliance (htg stove, hot water tank,furnace, etc.)to be installed in a Manufactur cjcj /lA bile Home? v YES NO SITE ADDRESS(911#/Road Name): Ca /�/v 3 6 Q�1,.y t,04-1 &t y �. Toi—/ 1.uc//0r� /� ZIP �j'�3 f� f 9 DIGIT PARCEL ID NUMBER �/ 1. 0 G1 0 sS 7 Legal Description: Subdivision Name Block Lot(s) �—Section / Township North, Range WM APPLICANT �1 t-1 ,1�e r /�� fig- PHONE ��bO) 4,3 7- Z/3 MAILING ADDRESS 6 3b ,,a2/7 v yi/-f y 4,-1 ' or- ,Luc 7vt� ZIP `r7i'36 PROPERTY OWNER " PHONE MAILING ADDRESS ZIP CONTRACTOR ( /\ )c 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 r uested and shall occur during regular business hours. APPLICANTS SIGNATURE —Jxee_ �, . , \."\,, a 0e Qrs, . DATE // / / .` / -7 OR OFFICE USE ONLY �- BASE FEE 7 I. RECEIPT# (0 CONSISTENCY REVIEW 3 •( U CASH/CK# A TOTAL J 0 O DATE /( / /L, 3 *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 i ' rt t -- i I � � i....___l T17T 1 .a_ _r___ 2o - - -0 ,-;"- \-- : ---.... \ d .N . ; T...) go 9_9 c� 0 Y.--)( i 7 ,ea j, ,c+ .