HomeMy WebLinkAboutBLD2003-00799 S
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 #: BLD03-00799 Received Date 12/22/2003
SITE ADDRESS: 110 WADES LOOP RD Issue Date 12/22/2003
CHIMACUM, 98325
APPLICANT: WILLIAM F DUNN TRUSTEE PHONE:
DEBORAH D DUNN TRUSTEE
110 WADES LOOP
CHIMACUM WA 983259752
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 901102005 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, WILLIAM F DUNN TRUSTEE PHONE:
if different: DEBORAH D DUNN TRUSTEE
110 WADES LOOP
CHIMACUM WA 983259752
PROJECT DESCRIPTION: NO MLA REQ'D -TWO ABOVE GROUND PROPANE TANKS
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 12/22/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[ ] FinalApproval:7-ANk 7C2.
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_Perm it_Propane.rpt 10/29/19f
UILDING PERMIT APPLICJ ON BLD03-00799
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00799 Received Date: 12/22/2003
SITE ADDRESS: 110 WADES LOOP RD
CHIMACUM, 98325
OWNER: WILLIAM F DUNN TRUSTEE PHONE:
DEBORAH D DUNN TRUSTEE
110 WADES LOOP
CHIMACUM WA 983259752
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 901102005 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 DESCRIPTION NO MLA REQ'D - TWO ABOVE GROUND PROPANE TANKS
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:
OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
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 12/22/03 60595
Total: $47.00
JEFFERSON COUNTY COMM,DEVELOPMENT,621 SHERIDAN ST,PORT TOWeD 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):
/10 "AY OE 3 Lo3P ('D
ell(/-(A�/y�° ( / �%ZIP 3ZT
9 DIGIT PARCEL ID NUMBER qo/'— 1 0 2- CO5"'
Legal Description:
Subdivision Name Block Lot(s)
y� Section �, 1 Township North, Range WM
V APPLICANT u I r 1 ) ► I� 11 + D-�I A PHONE 73 Li 2
MAILING ADDRESS 1(0 WA1y S Woe '-o
4
c In t w1CL^ ZIP el S
PROPERTY OWNER "' JR 1 N.j�'Vic-- PHONE
MAILING ADDRESS
t1
1i �7 ZIP
CONTRACTOR C• •J, PHONE 73 .-q 5)J
MAILING ADDRESS
ZIP
STATE LICENSE# O N c-, 16. 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 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 the appli is propert structure shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE r I Oil-- (4Al2J)< 4-i3 /( "al fill DATE /Z Z
- / 7 - / ('-��
FOR OFFICE USE ONLY
BASE FEE $47.00 RECEIPT# (CO 5C)\CD
CONSISTENCY REVIEW p `) CASH/CK# C A3 H
TOTAL 76 . DATE roe /' /a
*
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
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