HomeMy WebLinkAboutBLD2003-00770 41143
UILDING PERMIT APPLICAtON B RDOe 00057
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00770 Received Date: 12/10/2003
SITE ADDRESS: 593 HIGHLAND DR
PORT LUDLOW, 98365 l r
OWNER: KENNETI I L GRE-ENLEAF (�r � - kJ"-'�-- PHONE: -(d__, .__
C4Y -ORE -NLEAF'1?r'M\, e vG,'t�,Ac.
V e -tom 5613 trIran 9.�91 /l-
SUBDIVISION: SOUTH BAY#1 Block: Lot: 27
PARCEL NUMBER: 995500027 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 DESCRIPTIOI 120 GAL ABOVE GROUND PROPANE TANK, GAS PIPING AND
PROPANE HEAT STOVE
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 1997 HEAT BASE: HEAT TYPE:
OCCUPANCY:
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
•
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#: BLD03-00770 Received Date 12/10/2003
SITE ADDRESS: 593 HIGHLAND DR Issue Date 12/15/2003
PORT LUDLOW, 98365
APPLICANT: FRANK VAHCIC PHONE:
BONNIE VAHCIC
20-C FAIRWAY LANE
PORT LUDLOW WA 98365 27
SUBDIVISION: SOUTH BAY#1 Block: Lot:
PARCEL NUMBER: 995500027 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, FRANK VAHCIC PHONE:
if different: BONNIE VAHCIC
20-C FAIRWAY LANE
PORT LUDLOW WA 98365
PROJECT DESCRIPTION: 120 GAL ABOVE GROUND PROPANE TANK, GAS 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 12/15/2004.
REQUIRED INSPECTIONS:
[ ] elk in lianc • / 17/3
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[ ] FinalApproval: dK 4� 0 /2/7/ 3 ':
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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 10/29/19f
•SITE VISIT REPORT •
JOB JflHc.tc.
ADDRESS DATE ( 03-
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PHONE
Draw a simple plot plan: include property lines and proximityto lines,
shrubs & trees, exhaust vents, air intake, combustible sources, relevant win
tanks, wells, driveways,
Clallam County, include septic. House doves and doors. In
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JEFFERSON COUNTY COMMUNITY.ELOPMENT,621 SHERIDAN ST,PORT TOWNSEN A 98368 PH: (360)379-4450
• INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
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Underground PROPANE TANK* V Above Ground PROPANE TANK HEAT STOVE HOT WATER TANK
WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE
V OTHER(Please Specify) L ,
Is this appliance (htg stove, hotUlwate—tank,furnace,etc.)to be installed in a Manufactured/Mobile Home?
YES NO
ITE ADDRESS(911#/Road Name):
59 1
ZIP
DIGIT PARCEL ID NUMBER q 5 ' 5 c) o ^ d r
;gal Description:
Jbdivision Name Block_ Lot(s)
Section Township North, Range WM
,PLICANT t L� VCJ C t C- PHONE
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OPERTY OWNER " 0✓-C PHONE
ILING ADDRESS
ZIP
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LING ADDRESS / OAS 3 J G /
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TE LICENSE# c5 C.t y7,I � 07.7`[' P EXP.DATE i///
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fining the application form, the applicant/owner attests that the information provided herein is true and correct to the best of their knowledge. Any material
food 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.
ter agree to save, indemnify and hold harmless Jefferson County against all liabilities,judgments, court costs, reasonable attorney's fees and expenses which
n any way accrue against Jefferson County as a result of or in consequence of the granting of this permit.
ier agree to provide access and right of entry to Jeffers n'County and it's employees, representatives or agents for the purpose of application review and any
ed later inspections. Access and right of entry to the a licant's property or structure shall be requested and shall occur during regular business hours.
_ICANT'S SIGNATURE = y. DATE L.I-l /L / 4.713
t' 0, FOR OFFICE USE ONLY
BASE FEE • '11,, RECEIPT# ,1 i 00 S-
0-0
CONSISTENCY REVIEW -3 Sc' CASH/CK# %��
TOTAL 70 • DATE I2"/ `a /
arground Propane Tank applications require additional information to be submitted. OVER
a contact our office at 360-379-4450 if the back of this application is blank. 111111111*
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