HomeMy WebLinkAboutBLD2003-00712 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 #: BLD03-00712 Received Date 11/14/2003
SITE ADDRESS: 71 TOPSIDE CT Issue Date 11/18/2003
PORT LUDLOW, 98365
APPLICANT: STEVEN B SHANKLIN PHONE:
SHERRY A ROBINSON
4985 SW VULCAN CT
BEAVERTON OR 97007 55
SUBDIVISION: BAYVIEW VILLAGE DIV 3 Block: Lot:
PARCEL NUMBER: 931900055 Section: 16 Township: 28N Range: 01E
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTP198306 Expires 9/26/2004
OWNER, STEVEN B SHANKLIN PHONE:
if different: SHERRY A ROBINSON
4985 SW VULCAN CT
BEAVERTON OR 97007
PROJECT DESCRIPTION: PROPANE TANK AND FIREPLACE INSERT 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 11/18/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:—/74A k./Z/N IPPLi1dME - 9/0 1
6;,*
[ ] FinalApproval: ak Vet, C D % 9/�
BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS.
Office Hours 9:00 a.m. -4:30 p.m.
SPECIAL CONDITIONS APPLY - SEE REVERSE
HOT LINE AVAILABLE 24 HOURS A DAY
all
UILDING PERMIT APPLICAN BLD03-00712
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00712 Received Date: 11/14/2003
SITE ADDRESS: 71 TOPSIDE CT
PORT LUDLOW, 98365
OWNER: STEVEN B SHANKLIN PHONE:
SHERRY A ROBINSON
4985 SW VULCAN CT
BEAVERTON OR 97007
SUBDIVISION: BAYVIEW VILLAGE DIV 3 Block: Lot: 55
PARCEL NUMBER: 931900055 Section: 16 Township: 28 N Range: 01 E
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTP198306 Expires 9/26/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION PROPANE TANK AND FIREPLACE INSERT INSTALLATION
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW
VALUATION MAIN: O�O�
CODE EDITION: 1997 ADD'L: HEAT TYPE: 1 i
OCCUPANCY: HEAT BASE: HEAT TYPE: `` k
OCCUPANCY: UNHEATED: #OF STORIES: �CONST TYPE: OTHER: SHORELINE: (((���
CONST TYPE: GARAGE: SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL: rhPILSPIt 1
WATER SYSTEM: PARCEL TAGS: YES NO
BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA
Exist: Exist: Wetland Erosion NO
Prop: Prop: Seismic Streams No
Total: Total: Flood Wa Floodplain
yli_
Routing Date: F&W rf Landslide
Shoreli Aquifer NO
Forest: Commercial NO Rural
Type Amount Paid Bv: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 PRB 11/14/03 60371
Total: $47.00
r _ JEFFERSON COUNTY COMMUNI•VELOPMENT,621 SHERIDAN ST,PORT TOWNSWA 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 I HOT WATER TANK
WOODSTOVE x 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?
J, YES NO
SITE ADDRESS(911#/Road Name): rU
riI 1ov6icSe au et.
P0c+- LAA(UW ( ZIP
9 DIGIT PARCEL ID NUMBER — uv)U 1' t&J V t(lay -�- 9
Legal Description: U
Subdivision Name 11 1`UJ U U cr'��.. —Di kiStc5v1 Block Lot(s)
5-5--Section 1p Township North, Range t E_ WM
APPLICANT ¶fec)e Skan(c�t\ ff/ Clef c c��I'rISU1'1 PHONE 3(00 - �(37-'7,4>
MAILING ADDRESS 1(I IC)r;�51cLe �ol..c-Il'� ( o - �jO� - W.)L 1 O1'4 Lucc_ttIL6 ZIP C183(oS
PROPERTY OWNER `bc�rile ce-SGIN)l) PHONE
MAILING ADDRESS
ZIP
CONTRACTOR y ►`CJ� 41'k Kl U r92a it( C C��G > PHONE
MAILING ADDRESS u
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 Jeff on Coun a it's employees,representatives or agents for the purpose of application review and any required later
inspections. Access and right of entry a applicant' perty or t re sha be r nested and sshhh I occur during regular business hours.
APPLICANTS SIGNATURE Q!gyp /4,0WcJ DATE f I / ( / Q
FOR OFFICE USE ONLY
BASE FEE $47.00 RECEIPT# 6 l
CONSISTENCY REVIEW 2g t Sb CASH/CK# (QC`t
TOTAL -70.y0 DATE C( I I f I tJ*
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
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