HomeMy WebLinkAboutBLD2004-00041 • BUILDING PERMIT APPLI ION BLD04-00047
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00041 Received Date: 1/26/2004
SITE ADDRESS: 340 TALA SHORE DR
PORT LUDLOW, 98365
OWNER: WILLIAM J MARTENS PHONE:
DONNA J MARTENS
340 TALA SHORE DR
PORT LUDLOW WA 983659261
SUBDIVISION: TALA SHORES#3 Block: Lot: 5
PARCEL NUMBER: 998200305 Section: 15 Township: 28 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 DESCRIPTIOP No MLA Req'd -A/G propane tank, heat stove and fireplace insert
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 01/26/04 62515
Total: $48.00
sn''• JEFFERSON COUNTY COMM,Y DEVELOPMENT,621 SHERIDAN ST,PORT TO•ND WA 98368 PH: (360)379-4450
• INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* I, Above Ground PROPANE TANK* HEAT STOVE HOT WATER TANK
WOODSTOVE V 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):
—St-to ThLA Siloc1•- - oa-
k AA°l ZIP 6 `3 Gc
9 DIGIT PARCEL ID NUMBER ` l. j 2()30 c7
Legal Description:
Subdivision Name Block__.. Lot(s)
�- + Section Township North,
North, Range WM
APPLICANT V i�'Y{' n�Y11�4, f ` t C�r 1 ,�r1) PHONE , /!� .?q
MAILING ADDRESS 3�O gg�
(7'(` � 1C�✓ ZIP
PROPERTY OWNER PHONE
MAILING ADDRESS
/� [� ZIP
l_-- (" . �' JAN
CONTRACTOR � PHONE 2
MAILING ADDRESS
ZIP
STATE LICENSE# CJI�J '� 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 toto the a
pplicant's property or structure shall be requ sled and shall occur during regular business hours.
APPLICANTS SIGNATURE f-{ % IG � f; DATE / / / Or
OR OFFICE USE ONLY / �-�
BASE FEE $48.00 RECEIPT# 62-S I S—*
CONSISTENCY REVIEW $24.00� � CASH/CK# t'
TOTAL [ , DATE L /23/
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 #: BLD04-00041 Received Date 1/26/2004
SITE ADDRESS: 340 TALA SHORE DR Issue Date 1/27/2004
PORT LUDLOW, 98365
APPLICANT: WILLIAM J MARTENS PHONE:
DONNA J MARTENS
340 TALA SHORE DR
PORT LUDLOW WA 983659261 5
SUBDIVISION: TALA SHORES #3 Block: Lot:
PARCEL NUMBER: 998200305 Section: 15 Township: 28N 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, WILLIAM J MARTENS PHONE:
if different: DONNA J MARTENS
340 TALA SHORE DR
PORT LUDLOW WA 983659261
PROJECT DESCRIPTION: No MLA Req'd -A/G propane tank, heat stove and fireplace insert
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 01/27/2005.
REQUIRED INSPECTIONS:
[ ] (Applianc-: K4 _► _
[ ] FinalApprov. .---- �� -Ycr G/Q .I ----
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_Perm it_Propane.rpt 10/29/19