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HomeMy WebLinkAboutBLD2003-00775 i • 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 #: BLD03-00775 Received Date 12/12/2003 SITE ADDRESS: 2055 ANDERSON LAKE RD Issue Date 12/12/2003 CHIMACUM, 98325 APPLICANT: DENIS E FISK PHONE: LYNETTE FISK PO BOX 867 PORT HADLOCK WA 98339 T 66 SUBDIVISION: Block: Lot: PARCEL NUMBER: 901103004 Section: 10 Township: 29N 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, DENIS E FISK PHONE: if different: LYNETTE FISK PO BOX 867 PORT HADLOCK WA 98339 PROJECT DESCRIPTION: NO MLA REQ'D -ABOVE GROUND 120 GAL 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 12/12/2004. REQUIRED INSPECTIONS: [ ] Tank/Line/Appliance: [,qk FinalApproval: ( ( "2- ( jpt� 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� BLD03-00775 •UILDING PERMIT APPLICA�N Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD03-00775 Received Date: 12/12/2003 SITE ADDRESS: 2055 ANDERSON LAKE RD CHIMACUM, 98325 OWNER: DENIS E FISK PHONE: LYNETTE FISK PO BOX 867 PORT HADLOCK WA 98339 SUBDIVISION: Block: Lot: T 66 PARCEL NUMBER: 901103004 Section: 10 Township: 29 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 DESCRIPTIOI NO MLA REQ'D -ABOVE GROUND 120 GAL 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: 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 CJZ 12/12/03 60573 Total: $47.00 6 JEFFERSON COUNTY COMMU•DEVELOPMENT,621 SHERIDAN ST,PORT TOW,WA 98368 PH: (360)379-4450 INSTALLATION PERMIT APPLICATION MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION /Ao Underground PROPANE TANK* Above Ground PROPANE TANK'" ro 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): AAA"C ANVEgSoN- 4. " ZIP 9 DIGIT PARCEL ID NUMBER ?EV —JD 3"®0#7/ Legal Description: Subdivision Name Block Lot(s) Section Township North, Range WM APPLICANT ,�//S .A!S/�� PHONE 2/0- 0(.1Jer MAILING ADDRESS ,/�Jcj $ ,QA/Dff 3'O..) AA e R.L i_wd.r7" , ZIP PROPERTY OWNER s�/1�' PHONE MAILING ADDRESS ZIP CONTRACTOR C Atex 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 e Jefferson County and it' pl.,ees,representatives or agents for the purpose of application review and any required later inspections. Access and right of entry to th ppli nt's property or st . e sh. .e uested and shall occur during regular business hours. APPLICANTS SIGNATURE 1...404 / DATE 1I. //,2, /Q� FOR OFFICE USE ONLY BASE FEE $47.00 RECEIPT# �O51 3 CONSISTENCY REVIEW t. �J CASH/CK# I .) TOTAL /©' G� DATE fa , �a l 0z? _j 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. 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Nt' ,>, A `>1,, .I 02 •N`') - 0 -/u--4 - ..t'p?..1 R m en i 2 q TITLE: WASTEWATER SYSTEM PLANS JOHN SCOTT FLEMING ENGIN) F-9 to NEERING, INC. il N 1 TAX PARCEL # 901-103-004 /SF o b $ CLIENT: GALEN GARWOOD o zisz c84-7E'K4 k4' P.O. BOX 44 MAWS(' G4 PORT ANGELES, WA 98362 (360) 452-8500, FAX: (360) 452-3383