HomeMy WebLinkAboutBLD2003-00738 8
03-0073
BUILDING PERMIT APPLI ION ReviewBLD03-0073
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00738 Received Date: 11/24/2003
SITE ADDRESS: 152 W ISLAND VIEW
PORT TOWNSEND, 98368
OWNER: DAVID QUY PHONE:
DIANA LUDOVISSIE
PO BOX 114
PORT HADLOCK WA 983390114
SUBDIVISION: IRONDALE Block: 116 Lot: 1-4
PARCEL NUMBER: 962111601 Section: 34 Township: 30 N Range: 01 W
CONTRACTOR: C H S PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CHSIN**9790Z Expires 09/06/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP 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:
OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM: PARCEL TAGS: YES NO
BEDROOMS: BATHROOMS: STORMWATER: YE• NO AREA
Exist: Exist: Wetland Erosion
Prop: Prop: Seismic Streams
Total: Total: Flood Way Floodplain
Routing Date: F&W Landslide
Shoreline Aquifer TR
Forest: Corn ercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 CJZ 11/24/03 60442
Total: $47.00
•
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 #: BLD03-00738 Received Date 11/24/2003
SITE ADDRESS: 152 W ISLAND VIEW Issue Date 11/24/2003
PORT TOWNSEND, 98368
APPLICANT: DAVID QUY PHONE:
DIANA LUDOVISSIE
PO BOX 114
PORT HADLOCK WA 983390114 1-4
SUBDIVISION: IRONDALE Block: 116 Lot:
PARCEL NUMBER: 962111601 Section: 34 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, DAVID QUY PHONE:
if different: DIANA LUDOVISSIE
PO BOX 114 .
PORT HADLOCK WA 983390114
PROJECT DESCRIPTION: 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 11/24/2004.
REQUIRED INSPECTIONS:
[ ] igmtoi ine/Appliance:% /K.c . o9
[\I' FinalApprova C(p-21s O9'
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
• •
SPECIAL CONDITIONS FOR CASE#BLD03-00738:
1.) The applicant is proposing to site a 125-gallon propane tank on the property. The tank
shall maintain a minimum 10-foot setback from the edge of the right of way to the tank.
2.) The propane tank shall maintain a minimum 10-foot setback from the edge of the right
away to the tank.
I:\F_BLD_Permit_Propane.rpt 10/29/19.
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JEFFERSON COUNTY COMMUNODEVELOPMENT,621 SHERIDAN ST,PORT TOWD WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION (� p
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION D __------ --- ")
Underground PROPANE TANK* Above Ground PROPANE TANK* HEAT STOVE • WARTAKIK
N 4 2003
WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE xt t
OTHER(Please Specify) Jte+ter
Is this appliance(htg stove, hot water tank,furnace,etc.)to be installed in a Man'gfac"-urediklobile Home?
YES NO
SITE ADDRESS(911#/Road Name): /_
/5c W LAJb IE itt/ ,4Ve
�yJ/_ �J J // ,,-t ZIP �D
9 DIGIT PARCEL ID NUMBER -/6 1' / !1 C 1
Legal Description:
Subdivision Name Block Lot(s)
Section
Township North, Range WM
APPLICANT D A Y U 4U y PHONE 3 C( 5247 1
MAILING ADDRESS 7''D BQ 7C 271-
1l G p
pd 2r I'7b�oti� 1 I J 4- y�33� ZIP
PROPERTY OWNER c)�Y,1 G PHONE
MAILING ADDRESS S A
ZIP
CONTRACTOR C/G /V&-sX 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 t e a licant's property or structur hall equested and shah occur during regular business hours.
APPLICANTS SIGNATURE , I�C.0 G�-y�C� C GC'(j�/!,/1i1--��- DATE I/ l V(73"
FOR OFFICE USE ONLY
BASE FEE $47.00 RECEIPT# 6041 a.
CONSISTENCY REVIEW r 3
CASH/CK# 60
TOTAL , 5° DATE 11 /di' /94/3^3
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
G:\PermitCenter\FORMS\BLDG FORMS\ install-revised 10-30-03.DOC