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HomeMy WebLinkAboutBLD2003-00769 a 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 #: BLD03-00769 Received Date 12/10/2003 SITE ADDRESS: 101-2 HIGHLAND GREENS Issue Date 12/10/2003 PORT LUDLOW, 98365 APPLICANT: LORRAINE E WOOD PHONE: PO BOX 65167 PORT LUDLOW WA 98365 SUBDIVISION: HIGHLAND GREENS Block: Lot: PARCEL NUMBER: 959500025 Section: 21 Township: 28N Range: 01 E CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP"077QP Expires 11/17/2004 OWNER, LORRAINE E WOOD PHONE: if different: PO BOX 65167 PORT LUDLOW WA 98365 PROJECT DESCRIPTION: 120 GAL ABOVE GROUND PROPANE TANK, PIPING AND PROPANE HEAT STOVE 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 12/10/2004. REQUIRED INSPECTIONS: D I /; o [ ] CZifalApprova� .k 4 ,- , /2 /Q a3 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 I:\F_BLD_Permit_Propane.rpt 10/29/19 • SITE VISIT REPORT. JOB rr?,)? %%d DATE �z ADDRESS BY Z9 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 ty !. reetA5 Dr, Cyttace. l ,c p lerf C ' c/e- Courf`/a rd 12o Gc t(cM o It5- (z 8'Iadc�cr —'7 ( Raw; aped i dd r on d Pao1/ cce Description: Gfiaa / shae / Awe. , CGIS,?µtef 4/,,77aryak c <�e�ca�1`1 j‘,4s7toe%v %'O' c- d‘t S Ox k Gyi /ad toil Gf' / QXeii3 44, 5 D1` �Yu-��` ` • (c%i "424/ Y,, /Vd//1? /tQ,s6e /Yt 4/2.1r/e /i /e e. 3 UILDING PERMIT APPLICAON BL Review Type: Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD03-00769 Received Date: 12/10/2003 SITE ADDRESS: 101-2 HIGHLAND GREENS PORT LUDLOW, 98365 OWNER: LORRAINE E WOOD PHONE: PO BOX 65167 PORT LUDLOW WA 98365 SUBDIVISION: HIGHLAND GREENS Block: Lot: PARCEL NUMBER: 959500025 Section: 21 Township: 28 N Range: 01 E 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 DESCRIPTION 120 GAL ABOVE GROUND PROPANE TANK, PIPING AND PROPANE HEAT STOVE 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: F&W Landslide Shoreline Aquifer Forest: Commercial Rural Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $47.00 ZAN 12/10/03 60520 Total: $47.00 P S ' M, • JEFFERSON COUNTY COMMUNITYELOPMENT,621 SHERIDAN ST,PORT TOWNSEN.A 98368 PH: (360)379-4450 Y7/4f�'�b-J INSTALLATION PERMIT APPLICATION MARK ALL ITEMS BELOW THAT PERTAIN 10 THIS INSTALLATION Z© • (4-74-. Underground PROPANE TANK* Above Ground PROPANE TANK "HEAT STOVE HOT WATER TANK WOODSTOVE FIREPLACE INSERT _PELLET STOVE COOKING STOVE OTHER(Please Specify) &/ S' p i p e- . 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 (=. ( -- c)-- -c J 6-y-- ,,_,_,. ' ZIP e3 _j_'. 9 DIGIT PARCEL ID NUMBER Gly�s 95 00 0 Legal Description: Subdivision Name Block Lot(s) Section Township North, Range WM APPLICANT i—O r r a. //7 e tJv o oPHONE /73 7 q� U MAILING ADDRESS ,_j ( �, ZIP PROPERTY OWNER r: PHONE MAILING ADDRESS C� i ZIP CONTRACTOR �U" ii el'� PHONE MAILING ADDRESS /086--3 l' i.) v^, ste 64-,i— 'X I _- cD- [,. C,_ ZIP YcY 2 a 5 STATE LICENSE# ` 1' ,f' X 0 "7 7 0 I° EXP.DATE FEDERAL I.D.# J/ '—7, 2 f (1)J-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 J ter son County and it's employees, representatives or agents for the purpose of application review and any required later inspections. Access and of entry to t applicant's property or structure shall be requested and shall occur during regular business hours. APPLICANT'S SIGNATURE !/ r--v,/ �+ v _ DATE j l7 / a �1-ODFOR OFFICE USE ONLY BASE FEE RECEIPT# 2 0 CONSISTENCY REVIEW EzZS-Sa TOTAL '70 O CASH/CK# �� * DATE 2, /0,0 3 Underground Propane Tank applications require additional information to be submitted. OVER Please contact our office at 360-379-4450 if the back of this application is blank. EN* -I:W OME\PLNCNTRIINFOBLDG\FORMSVNSTALL.DOC