HomeMy WebLinkAboutBLD2004-00004 • 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 #: BLD04-00004 Received Date 1/6/2004
SITE ADDRESS: 4205 PARADISE BAY RD Issue Date 1/6/2004
PORT LUDLOW, 98365
APPLICANT: DELBERT L PERKINS PHONE:
LINDA S PERKINS
4205 PARADISE BAY RD
PORT LUDLOW WA 983659217 3
SUBDIVISION: PERKINS SHORT PLAT Block: Lot:
PARCEL NUMBER: 821262015 Section: 26 Township: 28N Range: 01E
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPI983O6 Expires 09/26/2004
OWNER, DELBERT L PERKINS PHONE:
if different: LINDA S PERKINS
4205 PARADISE BAY RD
PORT LUDLOW WA 983659217
PROJECT DESCRIPTION: NO MLA REQ'D - PROPANE TANK ABOVE GROUND 250 GAL & 2
HEAT STOVE
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 01/06/2005.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:- ,v /U '7K 1��F �/e' 4 AP/'L.JI4tvCs•'
sAs ,/
[ ] FinalApproval: Vprf 41( ne,—/ I6
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.
OBUILDING PERMIT APPLIC BLD04-00004
�ON Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00004 Received Date: 1/6/2004
SITE ADDRESS: 4205 PARADISE BAY RD
PORT LUDLOW, 98365
OWNER: DELBERT L PERKINS PHONE:
LINDA S PERKINS
4205 PARADISE BAY RD
PORT LUDLOW WA 983659217
SUBDIVISION: PERKINS SHORT PLAT Block: Lot: 3
PARCEL NUMBER: 821262015 Section: 26 Township: 28 N Range: 01 E
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTP198306 Expires 09/26/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr NO MLA REQ'D - PROPANE TANK ABOVE GROUND 250 GAL & 2
HEAT STOVE
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 $48.00 CJZ 01/06/04 62361
Total: $48.00
JEFFERSON COUNTY COMMU•DEVELOPMENT,621 SHERIDAN ST,PORT TOWOD WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION _ -�
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION_yyr►i 'h-tn �!� ,_` 15 i
/a[ s i„7,a1
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Underground PROPANE TANK* Above Ground PR PANE TANK* 2. HEAT STOVE OT WATER TANK • l
WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE " ' 4 rilr i
2004 ,.✓
0
OTHER(Please Specify) `` ..
Is this appliance (htg stove, hot water tank,furnace, etc.)to be installed in a Manu r /Mobile 1. f -' 1
_ YES" NO
SITE ADDRESS(911#/Road Name):
y2o5 ?A1 A- ts€ lay tRd.
ZIP `F$34S
9 DIGIT PARCEL ID NUMBER $L/Z . 0/3
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT -- eI- 3 r t- L. Pk--k k(N S PHONE CZOO) /f, '0 cz(03(Ce//)
MAILING ADDRESS 14205 %�P?1ptSE 43 Hy Rc .
ZIP
PROPERTY OWNER S/4 M I=E. PHONE
MAILING ADDRESS
ZIP
CONTRACTOR MDUN-f-i4//U -Pro pA N El- PHONE
MAILING ADDRESS
ZIP
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 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
applicant's propert or structureu shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE '• `` NU:� n/A DATE O f / OS- / 03
FOR OFFICE USE ONLY
BASE FEE $48.00 RECEIPT# W a 30 1
CONSISTENCY REVIEW $24.00 CASH/CK# 774 7
TOTAL 'U ,r° DATE _L/ 5/ CI
*
Propane Tank applications require additional information to be submitted. OVER Please contact our office at 360-379-4450 if the back of this application is blank.
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