HomeMy WebLinkAboutBLD2003-00789 •
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 #: BLD03-00789 Received Date 12/19/2003
SITE ADDRESS: 2 PHINNEY LN Issue Date 12/19/2003
PORT LUDLOW, 98365
APPLICANT: JANET F STARK PHONE:
2 PHINNEY LN
PORT LUDLOW WA 983659774
SUBDIVISION: PORT LUDLOW#1 Block: Lot:
PARCEL NUMBER: 990400172 Section: 16 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, JANET F STARK PHONE:
if different: 2 PHINNEY LN
PORT LUDLOW WA 983659774
PROJECT DESCRIPTION: NO MLA REQ'D -A/G 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 12/19/2004.
REQUIRED INSPECTIONS:
[Vr/ Tank/Line/Appliance:
[\.4/7 FinalApproval:Wi o o cC_ 0-13"Dy
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 10/29/19E
SITE VISIT REPORT
JOB i'i�rssy�Z,, . __'�� f' ' DATE /2�;
,ADDRESS BY —
PHONE
Draw a simple plot plan: include property lines and proximity to lines, tanks,
wells,
shrubs & trees, exhaust vents, air intake, combustible sources, relevant windows andddoo doors. In
Clallam County, include septic. House Mobile Home Commercial
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BUILDING PERMIT APPLICAI ON B Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend., WA 98368
PERMIT #: BLD03-00789 Received Date: 12/19/2003
SITE ADDRESS: 2 PHINNEY LN
PORT LUDLOW, 98365
OWNER: JANET F STARK PHONE:
2 PHINNEY LN
PORT LUDLOW WA 983659774
SUBDIVISION: PORT LUDLOW#1 Block: Lot:
PARCEL NUMBER: 990400172 Section: 16 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 DESCRIPTIOr NO MLA REQ'D -A/G 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 Bv: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 CJZ 12/19/03 60589
Total: $47.00
., JEFFERSON COUNTY COMMU•DEVELOPMENT,621 SHERIDAN ST,PORT TOWD WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION __,_�
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION r'"r."� E 1' , -"'-`"
* (1.-0 &iti • * i/ I I;
Underground PROPANE TANK Above Ground PROPANE TANK HEAT STOVI , HOT WATER TANK s
,� i°� ,1 rlr
WOODSTOVE t/FIR PLAACE INSERT PELLET STOVE COOKING STOVt1E c/
.......d ;
L- OTHER(Please Specify) &t4 PI Pin G
Is this appliance(htg stove, hot water tank,furnace,etc.)to be installed in a Marnfactured/Mobile Hobte7r-
a. YES r NO
SITE ADDRESS(911#/Road Name):
74-el p ,, ,j Ln
P7_ 1.(A.-d L-61...S , �e4 ZIP 9 4.345
9 DIGIT PARCEL ID NUMBER I r "n L f,C o / / Z
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT 1 CA-11-14t J `12)'Y -' c d4✓4I' (51 d' PHONE 43 7- 7 o/
MAILING ADDRESS
I. 0-Ell ,
ZIP II&kllIIlIIIIIIàIIL..L.i
,,
PROPERTY OWNER fill i«&Kg- PHONE
N DEC 19 2003
MAILING ADDRESS
ZIP
CONTRACTOR Jt(4M,,..4. er g PHONgiEFFERSON COUNTY DCD
MAILING ADDRESS )0S3 a4r112-1 L r
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STATE LICENSE# SUMS -l�t � Q-77 Q f EXP.DATE ///O y
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FEDERAL I.D.# %i - /d7 ( SS /
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 Jeff- en 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 plicant's iperty or structure shall be reques d and shall occur during regular business hours.
APPLICANTS SIGNATURE � A P P(/c 6.4j DATE I )---/ /7 / 03
FOR OFFICE USE ONLY �Q ��
BASE FEE $47.00 RECEIPT#
CONSISTENCY REVIEW a�]3/h•w CASH/CK# q 4 5 Co
TOTAL ` 0. DATE /a / 19 /&3
*
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