HomeMy WebLinkAboutBLD2003-00771 • 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 #: BLD03-00771 Received Date 12/10/2003
SITE ADDRESS: 34 TIMBER RIDGE DR Issue Date 12/10/2003
PORT LUDLOW, 98365
APPLICANT: PORT LUDLOW ASSOCIATES LLC PHONE: (360)437-2101
70 BREAKER LN
PORT LUDLOW WA 98365-9766
58
SUBDIVISION: TIMBERTON VILLAGE PHASE II Block: Lot:
PARCEL NUMBER: 998500058 Section: 17 Township: 28N Range: 01 E
CONTRACTOR: AIR FLO HEATING COMPANY INC PHONE: 360-683-3901
221 W CEDAR
SEQUIM WA 98382
OWNER, PORT LUDLOW ASSOCIATES LLC PHONE: (360)437-2101
if different: 70 BREAKER LN
PORT LUDLOW WA 98365-9766
PROJECT DESCRIPTION: 125 GAL ABOVE GROUND PROPANE TANK, FIREPLACE INSERT,
AND COOKING 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:
[ ] Tank/Lin e/Appliance:'-! L ,sue... fatimaidee /0/3 j -7, ,4N& 1/Jr c A c
:14v4 ek I lificgde /344/113A
[ ] FinalApprovaI: l/ -r�1r 7 v /L4//,3
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
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APPROVED I
SITE PLAN
DEC 18 2002 L,/,,
)EFFER ON O? • .:'02
DEPT.OF COM LOPMENT j i -
SIGNATURE: //, - . , 4
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•
BUILDING PERMIT APPLIC ION BLD02-00725
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00771 Received Date: 12/10/2003
SITE ADDRESS: 34 TIMBER RIDGE DR
PORT LUDLOW, 98365
OWNER: PORT LUDLOW ASSOCIATES LLC PHONE: (360)437-2101
70 BREAKER LN
PORT LUDLOW WA 98365-9766
SUBDIVISION: TIMBERTON VILLAGE PHASE II Block: Lot: 58
PARCEL NUMBER: 998500058 Section: 17 Township: 28 N Range: 01 E
CONTRACTOR: AIR FLO HEATING COMPANY INC PHONE: 360-683-3901
221 W CEDAR
SEQUIM WA 98382
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP 125 GAL ABOVE GROUND PROPANE TANK, FIREPLACE INSERT,
AND COOKING 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 60525
Total: $47.00
JEFFERSON COUNTY COMMU•DEVELOPMENT,621 SHERIDAN ST,PORT TOW ND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATI
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):
1 1 O V W ZIP9S866
9 DIGIT PARCEL ID NUMBER -0T 3E T 1 nl oei
Legal Description: S�
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT N N PHONE; %o —CO ( Cl3 0
MAILING ADDRESS 3� fts.jl ‘ V \If,�
4�k'(J+ -ill iA.(�Lou.)
u f w F� ZIP W��OJ(
PROPERTY OWNER G— /V V \ 6 ALA.( PHONE36v 6 -] 6 -7 L O C7
MAILING ADDRESS 0 ( ( ( ( iy f 90 b6& f>2
Utj,_Ln. `0,A.! W .. ZIP : 0
CONTRACTOR Th e. 1 G As 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 DATE
FOR OFFICE USE ONLY
BASE FEE $47.00 RECEIPT#
CONSISTENCY REVIEW ,3 •S o CASH/CK# / /C/
TOTAL 7O. S`° 2//DATE ! 0 103
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