HomeMy WebLinkAboutBLD2003-00790 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 #: BLD03-00790 Received Date 12/19/2003
SITE ADDRESS: 30 E EUGENE ST Issue Date 12/19/2003
PORT HADLOCK, 98339
APPLICANT: EDWIN R UDD PHONE:
ORENE M UDD
PO BOX 54
PORT HADLOCK WA 98339 15-19
SUBDIVISION: IRONDALE Block: 2 Lot:
PARCEL NUMBER: 961800204 Section: 34 Township: 30N Range: 01W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2004
OWNER, EDWIN R UDD PHONE:
if different: ORENE M UDD
PO BOX 54
PORT HADLOCK WA 98339
PROJECT DESCRIPTION: NO MLA REQ'D -PROPANE TANK ABOVE GROUND
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:
[ ] Tank/Line/Appliance:
FinalApproval: ' L 7 w'c c,,N�
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 10/29/19c
•UILDING PERMIT APPLICN B Review
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00790 Received Date: 12/19/2003
SITE ADDRESS: 30 E EUGENE ST
PORT HADLOCK, 98339
OWNER: EDWIN R UDD PHONE:
ORENE M UDD
PO BOX 54
PORT HADLOCK WA 98339
SUBDIVISION: IRONDALE Block: 2 Lot: 15-19
PARCEL NUMBER: 961800204 Section: 34 Township: 30 N Range: 01 W
CONTRACTOR: ' �Sh,\� � PHONE:
PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION NO MLA REQ'D - PROPANE TANK ABOVE GROUND
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 12/19/03 60589
Total: $47.00
JEFFERSON COUNTY COMMUNEVELOPMENT,621 SHERIDAN ST,PORT TOWN WA 98368 PH: (360)379-4450 •
—INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION i',IdO ^.:,r ^7t`�JO'ldril
Underground PROPANE TANK.*[� Above Ground PROPANE TANK* HEAT STOVE s rHOT WATER TANK-
WOODSTOVE FIREP INSERT PELLET STOVE COOKING STOVE 1 J 6 { 33u
v OTHER(Please Specify) f I I
Is this appliance (htg stove, hot water tank,furnace, etc.)to be installed in a 0frtured/i00 il4o
X." YES
SITE ADDRESS(911 #/Road Name):
3 Q E- E
'zj " ' �G�=��
P i - NLQc/c� UP ZIP
9 DIGIT PARCEL ID NUMBER 1 (/4 ( - QD - O
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT Lt 0c PHONE 3
�D �✓ �6 Z'
MAILING ADDRESS " ° $ I/
,P�r ZIP c 3 3 c.
PROPERTY OWNER Clap-4—C-b�,. PHONE
MAILING ADDRESS Ap�4
�� // ZIP
CONTRACTOR (P4/100 PHONE (7 S _ v 7 q7
MAILING ADDRESS 10 8S 3 Dr`
Y , / 41 4-tt)c— `� `'VA ZIP { 0 3 ; I
STATE LICENSE# .S 1 n S H() v 7 7 6-P EXP.DATE
FEDERAL I.D.# ' 1 /01 l ?
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 th pplicant's pro rty or structure shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE L /T DATE hZ/ G? / Q
FOR OFFICE USE ONLY 620
BASE FEE $47.00 RECEIPT# 5g
2 ° qA 5 co
REVIEW CASH/CK#
TOTAL 70. w DATE /l ct / aoo3
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 5 -�
G:\PermitCenter\FORMS\BLDG FORMS\install-revised 10-30-03.DOC
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• SITE VISIT REPORT
JOB &(/Oreoe t tt l DATE l2061
ADDRESS BY •
PHONE
Draw a simple plot plan: include property lines and proximily to lines, tanks, wells, driveways,
shrubs & trees, exhaust vents, air intake, combustible sources, relevant windows and doors. In
Clallam County, include septic. House Mobile Home Commercial
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