HomeMy WebLinkAboutBLD2003-00726 i •
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 #: BLD03-00726 Received Date 11/19/2003
SITE ADDRESS: 802 BLUE SKY DR Issue Date 11/20/2003
PORT TOWNSEND, 98368
APPLICANT: PATRICIA WEEDMAN PHONE:
802 BLUE SKY DR
PORT TOWNSEND WA 98368
8
SUBDIVISION: DISCOVERY RIDGE DIV III Block: Lot:
PARCEL NUMBER: 001195108 Section: 19 Township: 30N Range: 01W
CONTRACTOR: C H S PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CHSIN**9790Z Expires 09/06/2004
OWNER,
if different:
PROJECT DESCRIPTION: 250 GAL ABOVE GROUND 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 11/20/2004.
REQUIRED INSPECTIONS:
] Tank/Line/Applianc `1
[ FinalApproval:_ f I •.2.5-d3
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
UILDING PERMIT APPLICAON BLD95-00046R�1
Type:l
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00726 Received Date: 11/19/2003
SITE ADDRESS: 802 BLUE SKY DR
PORT TOWNSEND, 98368
OWNER: PATRICIA WEEDMAN PHONE:
802 BLUE SKY DR
PORT TOWNSEND WA 98368
SUBDIVISION: DISCOVERY RIDGE DIV III Block: Lot: 8
PARCEL NUMBER: 001195108 Section: 19 Township: 30 N Range: 01 W
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CHSIN**9790Z Expires 09/06/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION 250 GAL ABOVE GROUND 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: M` F&W Landslide
q Q 3 ii, Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid Bv: Date: Receipt: Approved/Date
Total:
JEFFERSON COUNTY COMMUN•EVELOPMENT,621 SHERIDAN ST.PORT TOWN.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 TANK
WOODSTOVE 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?
YES NO
SITE ADDRESS(911#/Road Name):
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-�C�V�J��•Q/� v' V ZIP ' t,'
9 DIGIT PARCEL ID NUMBER al!/Y5-/ro e
Legal Description:
Subdivision Name Block Lot(s)
Section �± -7�-(Tow�nship` North, Range WM
APPLICANT \V eE a �� i PA 1. (L' ` I"�r PHONE
MAILING ADDRESS S02-- - j`Lk-e,, ? D _ eye,
`'�i �
Iavo 1c;ci" :2 v V A ZIP (6�
PROPERTY OWNER �— 0 PHONE L
MAILING ADDRESS 2`>o l- F)We S y of LA v
i -t ' -\--'6w ri 2Arv,(-; ZIP 1 6 3 2' C" d �.P�(e`�
CONTRACTOR C-L Y i 7( ,G rii`� \ 5 ( PHONE % L. J' ' ���r
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 appli roperty or structure shal r?quested and shall ccur durin regular business hours. /
APPLICANTS SIGNATURE ' C r /L l 63
CSC►-- ��ry DATE / /
f' L j FOR USE ONLY / ']
BASE FEE "f_ RECEIPT#
b 0�f 3 /
CONSISTENCY REVIEW - SO CASH/CK# CA H
TOTAL 7 0 , Sb DATE 1//i 9 / 63
*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.
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