HomeMy WebLinkAboutBLD2004-00037 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 #: BLD04-00037 Received Date 1/23/2004
SITE ADDRESS: 41 AMES LN Issue Date 1/23/2004
PORT LUDLOW, 98365
APPLICANT: JASON WHITE PHONE:
41 AMES LANE
PORT LUDLOW WA 98365
SUBDIVISION: PORT LUDLOW NO 1 Block: Lot:
PARCEL NUMBER: 990400303 Section: 8 Township: 28N Range: 01 E
CONTRACTOR:
OWNER, JASON WHITE PHONE:
if different: 41 AMES LANE
PORT LUDLOW WA 98365
PROJECT DESCRIPTION: WOODSTOVE - NO MLA REQ'D
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 01/23/2005.
REQUIRED INSPECTIONS:
[ ] Taplk>L` e: ..•, 441LO 2 G,
[ 1 FinalApproval: � -Pier tu/z / / i oi/
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 BLD04-00037Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00037 Received Date: 1/23/2004
SITE ADDRESS: 41 AMES LN
PORT LUDLOW, 98365
OWNER: JASON WHITE PHONE:
41 AMES LANE
PORT LUDLOW WA 98365
SUBDIVISION: PORT LUDLOW NO 1 Block: Lot:
PARCEL NUMBER: 990400303 Section: 8 Township: 28 N Range: 01 E
CONTRACTOR: PHONE:
PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION WOODSTOVE - NO MLA REQ'D
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
Permit $48.00 CJZ 01/23/04 62394
Total: $48.00
JEFFERSON COUNTY COMMU,DEVELOPMENT,621 SHERIDAN ST,PORT TOW•D 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):
11 / iq lin €S . \
PC /J /' t,U / G f
qv
pA ( 71.1.) ZIP q Cb -iG c"
9 DIGIT PARCEL ID NUMBER / / 0 `I 00 d 3
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT PHONE
MAILING ADDRESS
ZIP
PROPERTY OWNER 3GZ S(t//r�� �( ) t PHONE
LI /l MAILING ADDRESS / V-1 S ►\ Q
POC l� /
-(1. ( QQJ ZIP GtJ 6S
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CONTRACTOR 0 Wh.e C/hal ( \'C'C PHONE 360— �t J 3 /-7
- //60
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 a applicant's property r truc re shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE , / '. (.I- �/vim DATE / / /
ti
FOR OFFICE USE ONLY BASE FEE $48.00 RECEIPT# 6 a 3C '11
t
CONSISTENCY REVIEW - CASH/CK# 0 1c
TOTAL "' 9 ' DATE I j /01
*
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