HomeMy WebLinkAboutBLD2004-00016 110 110
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 #: BLD04-00016 Received Date 1/12/2004
SITE ADDRESS: OAK BAY RD Issue Date 1/12/2004
PORT HADLOCK, 98339
APPLICANT: CHAD E WOODLEY PHONE:
HEATHER WOODLEY
3661 OAK BAY RD
PORT HADLOCK WA 983399730
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 921191004 Section: 19 Township: 29N Range: 01 E
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, CHAD E WOODLEY PHONE:
if different: HEATHER WOODLEY
3661 OAK BAY RD
PORT HADLOCK WA 983399730
PROJECT DESCRIPTION: NO MLA REQ'D -ABOVE GROUND PROPANE TANK 500 GAL
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 01/12/2005.
REQUIRED INSPECTIONS:
[V( Tan.t/Appliance: Dye / ,A '
61/
[ / FinalApproval: (5 - oY (h) /0• /y
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
\F_BLD_Permit_Propane.rpt 10/29/19c
'BUILDING PERMIT APPLIC,ION B Review
6
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00016 Received Date: 1/12/2004
SITE ADDRESS: 31,VO OAK BAY RD
PORT HADLOCK, 98339
OWNER: CHAD E WOODLEY PHONE:
HEATHER WOODLEY
3661 OAK BAY RD
PORT HADLOCK WA 983399730
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 921191004 Section: 19 Township: 29 N Range: 01 E
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 DESCRIPTIOI NO MLA REQ'D -ABOVE GROUND PROPANE TANK 500 GAL
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
Permit $48.00 CJZ 01/12/04 62379
Total: $48.00
JEFFERSON COUNTY COMMUDEVELOPMENT,621 SHERIDAN ST,PORT TOWD WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION 2 - r' 7 ^�' 1
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION D l�� 6,1 ': r
Underground PROPANE TANK* Above Ground PROPANE TANK* HEAT STOVE r!H(T WAA I 1
i4f ..
WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE t
OTHER(Please Specify)
i;yPT OF G�'' JE'vE OP-Ma ivf
Is this appliance(htg stove, hot water tank,furnace,etc.)to be installed in a Manufac" ured7Mobite tamne7`
YES NO
SITE ADDRESS(911#/Road Name):
3t o cx�Ki Oa li fLO. �y� j �--
TO1'~� UL&DIOV`-) jj ZIP ��'u�6s
9 DIGIT PARCEL ID NUMBER I Z- r .. ! �'I ! '- (.a c)ii
Legal Description:
Subdivision Name Block Lot(s)
Section^ Q Township
Q North, Range ) `� WM
APPLICANT V Vt/ 1/4 ' i �i� (� `ITH PHONE 3�al - ) l 7
MAILING ADDRESS .31(21) pew_ ��,,'( q-o,
t: ' UActo ,) ZIP
PROPERTY OWNER PHONE
MAILING ADDRESS
ZIP CONTRACTOR ° ' j •-7, PHONE 15 G `,
�"5ig
MAILING ADDRESS e d Q 2-Sfq
C,ft. l ' t•l( ZIP q V
STATE LICENSE# CIA) IL/t� ' 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 a plicant's propert.or structure shall be requestedqu nd shall occur during regular business hours.
APPLICANTS SIGNATURE t C "ra � ,y DATE r' / (/
/d V
-42 FOR OFFICE USE ONLY ^
BASE FEE $47.00 RECEIPT# a �(�1.
CONSISTENCY REVIEW a� CASH/CK# IA t 1
TOTAL rio`?,n DATE I / aa-/ 04
*
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 4
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