HomeMy WebLinkAboutBLD2003-00758 •
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 #: BLD03-00758 Received Date 12/5/2003
SITE ADDRESS: 3985 W VALLEY RD Issue Date 12/5/2003
CHIMACUM, 98325
APPLICANT: SCOTT R BRODERSON PHONE:
KRISTIE BRODERSON
3985 W VALLEY RD
CHIMACUM WA 983258715
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 901342012 Section: 34 Township: 29N Range: 01W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTP1983O6 Expires 09/26/2004
OWNER, SCOTT R BRODERSON PHONE:
if different: KRISTIE BRODERSON
3985 W VALLEY RD
CHIMACUM WA 983258715
PROJECT DESCRIPTION: MO MLA REQ'D-A/G 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 12/05/2004.
REQUIRED INSPECTIONS:
[ ] ank/Line/ ppliance:0`� [I— r O-0_3
[v( FinalApproval: W CA1+ l2'lo
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#BLD03-00758:
1.) The proposed propane tank is proposing to maintain a 50-foot lot line setback.
2.) Pursuant to UDC Section 3.6.4f.vi, propane tanks are exempt from review under
environmentally sensitive areas.
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BLD03-00758
°BUILDING PERMIT APPLICA ION Review Typ e:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00758 Received Date: 12/5/2003
SITE ADDRESS: 3985 W VALLEY RD
CHIMACUM, 98325
OWNER: SCOTT R BRODERSON PHONE:
KRISTIE BRODERSON
3985 W VALLEY RD
CHIMACUM WA 983258715
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 901342012 Section: 34 Township: 29 N Range: 01 W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPI983O6 Expires 09/26/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION MO MLA REQ'D-A/G 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: YES NO
Exist: Exist: Wetland Erosion /AREA
Prop: Prop: Seismic Streams
Total: Total: Flood Way Floodpl*
Routing Date: F&W Landslide
Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Ap roved/Date ✓� v )
Propane Tanks/Stoves $47.00 CJZ 12/05/03 60554 n�
Total: $47.00 U
JEFFERSON COUNTY COMMUNJEVELOPMENT,621 SHERIDAN ST.PORT TOWN•D 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):
.i i Vvr . /,/ ZIP ?3 Ld
9 DIGIT PARCEL ID NUMBER `' (,I L
Legal Description:
Subdivision Name Block Lot(s)
Section ., Township North, Range ! WM
APPLICANT Kir;S ti ( btO E'V-&OV PHONE lot- Li/%1 $se
MAILING ADDRESS 697 VJ St khtt(( 9 •
ZIP
PROPERTY OWNER LAC 0 l l $ '` rl<_s-k i e., brode c, ` VI PHONE
MAILING ADDRESS V a tint,
ZIP
( r Pro-bil x (� ro F7I1€G 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 requested and shall occur during regular business hours.
APPLICANTS SIGNATURE „ J . L~_ } ,..,. �`,,��-'J.t-" � " DATE i /L L.
� / M
_
FOR OFFICE USE ONLY
BASE FEE $47.00 RECEIPT# (t 0?�fi l
CONSISTENCY REVIEW a 3 L� . . CASH/CK# 51 I q
TOTAL ' C% 7 DATE I / ,t3 'Roo-3
Propane Tank applications require additional in iorito be submitted. -)I `
Please contact our office at 360-379-4450 if the bahis application is blank. !U OVER
,. DEC - 5 2003 � °
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G:\PermitCenter\FORMS\BLDG FORMS\_install-revised 10-30-03.DOC