HomeMy WebLinkAboutBLD2004-00005 •
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 #: BLD04-00005 Received Date 1/6/2004
SITE ADDRESS: 93 LONE STAR Issue Date 1/6/2004
QUILCENE, 98376
APPLICANT: JEANNE R KLINGENSMITH PHONE:
614 NW 182ND ST
SHORELINE WA 98177
T3
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 701052005 Section: 5 Township: 27N Range: 01W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPI983O6 Expires 09/26/2004
OWNER, JEANNE R KLINGENSMITH PHONE:
if different: 614 NW 182ND ST
SHORELINE WA 98177
PROJECT DESCRIPTION: NO MLA REQ'D - PROPANE TANK AG 500 GALLON
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: AA* 'E Auk- 2311 /2iSffr
[ FinalApproval: 4 - 47(wa,/ 41/tO/f
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.
UILDING PERMIT APPLIC•ON BLD04 00005
w Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00005 Received Date: 1/6/2004
SITE ADDRESS: 93 LONE STAR
QUILCENE, 98376
OWNER: JEANNE R KLINGENSMITH PHONE:
614 NW 182ND ST
SHORELINE WA 98177
SUBDIVISION: Block: Lot: T3
PARCEL NUMBER: 701052005 Section: 5 Township: 27 N Range: 01 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 DESCRIPTIOr NO MLA REQ'D - PROPANE TANK AG 500 GALLON
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 62365
Total: $48.00
JEFFERSON COUNTY COMMUI'JEVELOPMENT,621 SHERIDAN ST,PORT TOWD WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
C Ces ��
Underground PROPANE TANK* 1- Above Ground PROPANE TANK* HEAT STOVE b' 'WATER TANK ---
WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE i i 4,4 INN i 1 71
OTHER(Please Specify)
Is this appliance (htg stove, hot water tank,furnace, etc.)to be installed in a Manu c r d/Mobile Home?
� YE �"-Nb
SITE ADDRESS(911#/Road Name):
ZIP
9 DIGIT PARCEL ID NUMBER "7 D t O 5 ?' " Q
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT o 4^r1V L/ •C5Cc-i S/ PHONE
MAILING ADDRESS Ise JCS (iP i $•J- Na S /
f-{ r;F L e' WA? 9‘ .2 j 7 ziP
PROPERTY OWNER PHONE
MAILING ADDRESS
ZIP
CONTRACTOR ),a l?L 4 rv' ✓/4 (A.r), qn/ 240/ /// PHONE
MAILING ADDRESS 3 f 1 to E yyl 77✓ }Ko ,q O / t 1 )A
t/fT'
C61 r JIIA c u Vr, cri//n, 4`a
/ ZIP '7.�-5
STATE LICENSE# 134 vY� co t7 C lj EXP.DATE 7-- -'-} - }was
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 r structure shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE DATE / 6' / y
FOR OFFICE USE ONLY
BASE FEE $48.00 RECEIPT#
CONSISTENCY REVIEW 4 $24.00 CASH/CK# 142 O O
TOTAL rA 0.0 DATE / / 6 /0
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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ORIENTATION TO PARCEL TAKEN FROM..
ARNOLD 6VOOD SURVEY RECORDED I1/1/94.