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HomeMy WebLinkAboutBLD2003-00722 BUILDING PERMIT APPLIC ION B RD03-00722 Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD03-00722 Received Date: 11/18/2003 SITE ADDRESS: 201 BRIGHTON AVE PORT HADLOCK, 98339 OWNER: MATTHEW MC CLEARY PHONE: STEPHANIE MC CLEARY 201 BRIGHTON ST PORT HADLOCK WA 983398508 SUBDIVISION: SHOLD'S ADDITION Block: Lot: PARCEL NUMBER: 994800206 Section: 2 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 INSTALL PROPANE TANK,FIREPLACE INSERT AND PIPING 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 -f" AREA Exist: Exist: Wetland A) o Erosion r}p Prop: Prop: Seismic N Streams N Total: Total: Flood Way ,rJ V Floodplain Routing Date: t F&W Toil?it rnw�Ai Landslide sh 14 se t i G- PP9j111, Shoreline N U Aquifer ,5 us - Forest: Commercial Rural N Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $47.00 PRB 11/18/03 60380 Total: $47.00 0 0 PROPANE/PELLET/WOOD STOVE & TANK INSTALLATION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD03-00722 Received Date 11/18/2003 SITE ADDRESS: 201 BRIGHTON AVE Issue Date 11/18/2003 PORT HADLOCK, 98339 APPLICANT: MATTHEW MC CLEARY PHONE: STEPHANIE MC CLEARY 201 BRIGHTON ST PORT HADLOCK WA 983398508 SUBDIVISION: SHOLD'S ADDITION Block: Lot: PARCEL NUMBER: 994800206 Section: 2 Township: 29N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2004 OWNER, MATTHEW MC CLEARY PHONE: if different: STEPHANIE MC CLEARY 201 BRIGHTON ST PORT HADLOCK WA 983398508 PROJECT DESCRIPTION: INSTALL PROPANE TANK,FIREPLACE INSERT AND PIPING THIS PERMIT IS VALID FOR ONE YEAR AND IS NOT RENEWABLE. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 11/18/2004. REQUIRED INSPECTIONS: [- \ Tank/Line/Appliance: d/r--- //A./..,,,,-2, ...„ __�._: -, [ ] FinalApproval: '.2 _05f BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS. Office Hours 9:00 a.m. -4:30 p.m. SPECIAL CONDITIONS APPLY - SEE REVERSE HOT LINE AVAILABLE 24 HOURS A DAY JEFFERSON COUNTY COMMUNI•VELOPMENT,621 SHERIDAN ST.PORT TOWNS WA 98368 PH: (360)379-4450 INSTALLATION PERMIT APPLICATION MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION 5 p O rflO Underground PROPANE TANK* Above Ground PROPANE TANK HEAT STOVE HOT WATER TANK 6 WOODSTOVE " FIREPLACE INSERT PELLET STOVE COOKING STOVE -OTHER(Please Specify) O"09J ,P!f P nK Is this appliance(htg stove, hot water tank,furnace, etc.) to be installed in a Manufactured/Mobile Home? YES NO SITE ADDRESS(911#/Road Name): I S t:.0-C-4. J �"` ZIP 9 DIGIT PARCEL ID NUMBER 9'TL / v���© 20 Legal Description: Subdivision Name Block Lot(s) Section Township North, Range WM • APPLICANT l / 1 /1/C CX$�'7 PHONE 37 9- u ° MAILING ADDRESS ZIP PROPERTY OWNER -47a111-4—c..`,.-i.-7 PHONE MAILING ADDRESS ._4.{ ZIP ry 6. CONTRACTOR ) (344)04y- - PHONE 3 FJ 3 i 7 MAILING ADDRESS J08 �� / U U i `2. , ( ZIP !2. ,�r STATE LICENSE# �((+SG(�I T/V 1" 0 7 7 C/ EXP.DATE t/77 V47 FEDERAL I.D.# [/ / 2 Y5 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 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 pr perty or structure shall be requested and shall occur during regular business hours. APPLICANTS SIGNATURE .r DATE r / I ?l - FOR OFFICE USE ONLY V y, BASE FEE 41.06 RECEIPT# CONSISTENCY REVIEW 23 'S� CASH/CK# q/' ,BUJ l TOTAL 4 70 • t DATE *Underground Propane Tank applications require additional information to be submitted. 0 V E R 10- 10- 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 • SITE VISIT REPOR ADDRESS i `7 /'t, fC�,�, ,�` DATE '/ /-;: ; BY 71,1 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. Ir Clallam County, include septic. House_ Mobile Home Commercial i i i I I i 1 i ; ='cc p; __ S I / \ _ _�_ obi /. l Ti Gc i 1 J. 1, ,Oi .S pJ//ear /-),�r/> 1 II •r L Description: e / / ''' cf f' .. Y r_•k•./ -7,`,,.�, ,.., , , SITE VISIT REP ORT JOB /S`�/ ' (1 ?1e MC ,Cf/' ' DATE ADDRESS BY 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 tdd ----- 7 / _. _ r ,,,,,,,N,//7 0 ort ic "4 , \\ 4 Description: