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Home My WebLink AboutBLD2004-00010 • BUILDING PERMIT APPLIC ION B RDOe 00010 evi Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD04-00010 Received Date: 1/7/2004 SITE ADDRESS: 890 BERRY HILL LN CHIMACUM, 98325 OWNER: LARRY E WILSON PHONE: SANDRA K WILSON 1805 CONGRESS ST LAFAYETEE IN 479051268 SUBDIVISION: Block: Lot: 9 PARCEL NUMBER: 901333014 Section: 33 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 125 GAL ABOVE GROUND PROPANE TANK TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 1997 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: 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: 1' /0Y F&W Landslide Shoreline Aquifer 1` (� Forest: Commercial Rural Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $48.00 ZAN 01/07/04 62402 Total: $48.00 JEFFERSON COUNTY COMMSY DEVELOPMENT,621 SHERIDAN ST,PORT TOEND 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 r 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 '�f Z.1 12 r r a L. �CJ r T .. ( 0 wJ h Se'A d'`✓ 441 ZIP -*effIgWO ‘ er 36 8. 9 DIGIT PARCEL ID NUMBER q [ // 733 0/ r`/ Legal Description: Subdivision Name Block Lot(s) Section Township North, Range WM WM -" f' Fot /% APPLICANT . -c- e n PHONE .r ✓7 e °j MAILING ADDRESS d l ✓i/J`, — �,// L11 PO r; ) 0t.✓r5,V'I V" -,-e t ZIP gi lee e PROPERTY OWNER PHONE MAILING ADDRESS ZIP CONTRACTOR Le f'1, PHONE f 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',""employees,representatives or agents for the purpose of application review and any required later inspections. Access and right of entry to the apptfcant's property'or stru II be request all occur during regular business hours. APPLICANTS SIGNATURE ` ! DATE / 9 / ,!` FO FFIC SE ONLY BASE FEE `" $48.00' RECEIPT# (a(40a CONSISTENCY REVIEW $24.00 CASH/CK# (0 l / TOTAL (ti , /02._ o'D DATE j_/ / _QY * 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. G:\PermitCenter\FORMS\BLDG FORMS\install-revised 10-30-03.DOC • 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 #: BLD04-00010 Received Date 1/7/2004 SITE ADDRESS: 890 BERRY HILL LN Issue Date 1/7/2004 CHIMACUM, 98325 APPLICANT: LARRY E WILSON PHONE: SANDRA K WILSON 1805 CONGRESS ST LAFAYETEE IN 479051268 g SUBDIVISION: Block: Lot: PARCEL NUMBER: 901333014 Section: 33 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, LARRY E WILSON PHONE: if different: SANDRA K WILSON 1805 CONGRESS ST LAFAYETEE IN 479051268 PROJECT DESCRIPTION: 125 GAL ABOVE GROUND 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 01/07/2005. REQUIRED INSPECTIONS: [ ] Tank/Line/Appliance: liztVe-/ liLwci,“...-4-0 [ ] FinalApproval: �� 7 )_7'O) 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_Permit_Propane.rpt 10/29/19 I, - _ 1 / (1( ---6., i se// ,e ..........„ r\\ , - r-\\ . L. , .... tlit , 4,7 1 .... ,,,..............._____ .......__ .._ .......,„ _ _.... , ......._ '------, • • .