HomeMy WebLinkAboutBLD2003-00783 F
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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 #: BLD03-00783 Received Date 12/16/2003
SITE ADDRESS: 310 HADLOCK BAY RD Issue Date 12/16/2003
PORT HADLOCK, 98339
APPLICANT: PORT HADLOCK/K S C LLC PHONE:
C/O REALVEST CORP
1111 MAIN ST STE 700
VANCOUVER WA 986602970 T 31+
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 901014007 Section: 1 Township: 29N Range: 01W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTP198306 Expires 9/26/2004
OWNER, PORT HADLOCK/K S C LLC PHONE:
if different: C/O REALVEST CORP
1111 MAIN ST STE 700
VANCOUVER WA 986602970
PROJECT DESCRIPTION: PROPANE LINE INSTALLATION
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 12/16/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: fie,PWA)g- hoe DArLy / //97� Gi7`
[ Ina Approv . !/1� �e�— 4/0 / 9 45 0
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
UILDING PERMIT APPLICA•N B Review
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00783 Received Date: 12/16/2003
SITE ADDRESS: 310 HADLOCK BAY RD
PORT HADLOCK, 98339
OWNER: PORT HADLOCK/K S C LLC PHONE:
C/O REALVEST CORP
1111 MAIN ST STE 700
VANCOUVER WA 986602970
SUBDIVISION: Block: Lot: T 31+
PARCEL NUMBER: 901014007 Section: 1 Township: 29 N Range: 01 W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTP198306 Expires 9/26/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION PROPANE LINE INSTALLATION
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
17/I g(p 03 ( Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 PRB 12/16/03 62305
Total: $47.00
JEFFERSON COUNTY COMMUNI6EVELOPMENT,621 SHERIDAN ST,PORT TOWN*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):
j �`
A' P {el l',, ZIP 5)
9 DIGIT PARCEL ID NUMBER C 0 I ON DO-7
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
J
APPLICANT \/ V `l 0 G tit PHONE Zj p ( 3
MAILING ADDRESS 00 p�?C ' pv\ V r
t pio, G,J ZIP 6.0)- 3«l
PROPERTY OWNER J,-,kiA l U\I I1ts yyd'•'n PHONE
MAILING ADDRESS 1`D \ki\fl,OtL PV\
di k \\MJ C I\ Lo ZIP SSc)
CONTRACTOR \Y�CJ0y1\b)\ VG`P(�Ak_ PHONE 7V' V2- 3
MAILING ADDRESS WNUlllcjtL .,'
ZIP -l4 2f)
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 re ct to this application packet may result in this permit being null and void.
I further agree to save,indemnify and hold harmless Jefferson Count ag pst all liabilities,judgments,court costs,reasonable attorney's fees and expenses which may in any
way accrue against Jefferson County s a result of or consequence o he granting of this permit.
I further agree to provide access and ri of erfiry to ffe on County and''s employees,representatives or agents for the purpose of application review and any required later
inspections. Access and right of entry to aplilicartt' pro erty or structure hall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE )( . ‘— � \ DATE \-L'' / k / t
\ FOR OFFICE USE ONLY
BASE FEE $47.00 RECEIPT#
CONSISTENCY REVIEW 0 CASH/CK#
TOTAL 47.CO DATE / /
*
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