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HomeMy WebLinkAboutBLD2003-00786 • 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 #: BLD03-00786 Received Date 12/18/2003 SITE ADDRESS: 275 LOVERS LN Issue Date 12/18/2003 BRINNON, 98320 APPLICANT: MIKE FISHER PHONE: CAROL J FISHER PO BOX 1725 REDMOND OR 977560517 2 SUBDIVISION: Block: Lot: PARCEL NUMBER: 502103023 Section: 10 Township: 25N Range: 02W CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTP198306 Expires 09/26/2004 OWNER, MIKE FISHER PHONE: if different: CAROL J FISHER PO BOX 1725 REDMOND OR 977560517 PROJECT DESCRIPTION: NO MLA REQ'D -ABOVE GROUND 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 12/18/2004. REQUIRED INSPECTIONS: [ ] Tank/Line/Appliance: iOPANE /ANK I/44 44.)[.Y //3/ail [ ] FinalApproval: AiPANE lio& 4 EX7,,eAo e /40E. 4N4Y� .t-ct 0 /43/.0i(10 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 is\F_BLD_Permit_Propane.rpt 10/29/19.c BUILDING PERMIT APPLIC ION BLDOe 007786 Reviw Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD03-00786 Received Date: 12/18/2003 SITE ADDRESS: 275 LOVERS LN BRINNON, 98320 OWNER: MIKE FISHER PHONE: CAROL J FISHER PO BOX 1725 REDMOND OR 977560517 SUBDIVISION: Block: Lot: 2 PARCEL NUMBER: 502103023 Section: 10 Township: 25 N Range: 02 W CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTPI983O6 Expires 09/26/2004 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP NO MLA REQ'D -ABOVE GROUND 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 12/18/03 60586 Total: $47.00 Jvv :i U ,I cis I'ikli •U-Uc JJ/11VI; -aae z '2 Z c Q 0 _.-.+ y j _ u co o S o "� 4, •3 c c m • (p cD ' n� �n n �' m a �• o� j. a cn cp 1 r" • o n m o -z a CO -' cp a�_ m cn cnco o cfp a m n w w n'� x o o m c z 0 rn cn. 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OF COMMtiNrvnrvn rlDucult - • ,IEFFRSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWN$END 1/y A 91}, PH: (380)379-4450 INSTALLATION PERMIT APPLICATION MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION -f2-60 CrA))fso' Underground PROPANE TANK* XC' 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 Nl SITE ADDRESS(911#/Road Name): 0 7S 400 c.,e s L ANc. ei1/N©n/ W A ZIP qR, 00!" 9 DIGIT PARCEL ID NUMBER S©Z— )03--o y Legal Description: Subdivision Name fl _XjA _ Pi 6 CiE Block Lot(s) X.- Section /6 Township 7S North, Range CCl yeti APPLICANT inii 1?E. Fri/77( PHONE-S YJ- .Sys /6 7,S- MAILING ADDRESS P I &. Re)Ai / 7,2 as R (1 yV.) C7 le. ZIP C 7 7,54 PROPERTY OWNER S4 In£ PHONE MAILING ADDRESS ZIP g� CONTRACTOR Mil JNTil-/Al P 10AA) ' PHONE S c, 4 -__ c MAILING ADDRESS din,c. C 11/MAC tlyr' R b k r I,LRD/n c k exi 6 ZIP q 3.3 C1 STATE LICENSE# _ i M./A.1-p I-- C7 CI 9 1R/4 _ 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 applicanVowner with respect to this application packet may result In this permit being null and void. I further agree to save,Indemnity and hold harmless Jefferson County agalnet all liabilities,judgments,court costs,reasonable attorney'a 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. 1 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 a apt nrs property or structure shall be requested and shall occur during regular business hours. APPLICANTS SIGNATURE Cam__ C, DATE AR / /S / ' {d!iryT'A+vry �4<t i� �� ra�I.ix°"�\�u vu�aRi�Yra�^vr��,�,:�.�,r,,y.e ;.�a; �.. :r., L V r v' Y�.:Y 1`�iCaa�k�14^�n✓F '�' r u t t l ct�, i r aI t��t } r r!mn5nra s+ yy¢ �( e 4,.� '{{,�N pp 1.JFi �b k r 4 is 4` 4l./S.E,.,/ t/ i1 . ,;.,,i�I 1#44,S�,A,i,,�,7 .iR' LM bvif., , 14,1 i� !r4i�,4,01 P4i31'�4.1�+;i�. r,�� ^ 1,, i: • �.{�i�i i�,:W o �,,1.9,,�;`FY��,,,,,c -��;9 ;!A;f ), i,G;9r '4F°". y4 Y ����� .WA la.l� t� � � Yv a��:,j,,\``Z;< {i 1.PY ! 4 Wyk r� 9 �.. r'f1"'* t��,d" F � ,fl' ��tilna'11"�9d'Q�� '�tti K xr 1, . d !: �. Q arn,.,:�i141rrd " ,t �u� � :r , ,o t r 4 {..T.,' yypytt� ��r1rt�N\�,i ,i t� 5)f �4 I "e1�jj r,�.,�J ..r P �y kx � ,. ^may..i1 ,alr��i.'�, k�,dh Sw4�� .��v �� � � A�aiiti Ym n �� n ' �� ' ,/2tY r 12t F tial �. ( QV,c.; 1 rig9 i< Me F} � �1 �` i�' I��� j.�"�:: t 4 r�� Propane Tank applications require additional information to be submitted. ( J?id' W- Please contact our officeat 360-379.4450 If the back of this application is blank. OVER 4 4 4 4, -P em IT 0z onYI G:\PermitCenter\FORMS\BLDG FORMS\,,,Install-revised 10-30-03.DOC "0 39`.;d COQ DO d9�L' TgtbRiRAW' p7 :bT r'far 7icT/7T