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HomeMy WebLinkAboutBLD2004-00046 0 • 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 #: BLD04-00046 Received Date 1/26/2004 SITE ADDRESS: 640 BLACK BEAR RD Issue Date 1/28/2004 PORT TOWNSEND, 98368 APPLICANT: ROBERT M BUCK JR PHONE: DACIA D MORRISON BUCK 640 BLACK BEAR RD PORT TOWNSEND WA 983689733 T 23 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001294007 Section: 29 Township: 30N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2004 OWNER, ROBERT M BUCK JR PHONE: if different: DACIA D MORRISON BUCK 640 BLACK BEAR RD PORT TOWNSEND WA 983689733 PROJECT DESCRIPTION: ABOVE GROUND PROPANE TANK&GAS PIPING 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 01/28/2005. REQUIRED INSPECTIONS: [-6cnk/Line ppliance: C J3_p7 rr FinalApproval I:3-t7 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 • BUILDING PERMIT APPLICtTION BLD04-000046 view Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD04-00046 Received Date: 1/26/2004 SITE ADDRESS: 640 BLACK BEAR RD PORT TOWNSEND, 98368 OWNER: ROBERT M BUCK JR PHONE: DACIA D MORRISON BUCK 640 BLACK BEAR RD PORT TOWNSEND WA 983689733 SUBDIVISION: Block: Lot: T 23 PARCEL NUMBER: 001294007 Section: 29 Township: 30 N Range: 01 W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2004 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION ABOVE GROUND PROPANE TANK & GAS PIPING TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 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 v F&W Landslide Routing Date: ` I2--7 10 it1"-- Shoreline Aquifer Forest: Commercial Rural Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $47.00 KAS 01/26/04 62470 Total: $47.00 APPROVED JAN 2 9 2004 Jefferson County Planning & Building Defr if —--v•—.—-, i..,-s 4-1" .. i ii 4 (e 100. 4 SITE VISIT REPORT ``` Z JOB Cycr ' �/137`sewback . DATE /2©9lb. ADDRESS BY Z/1 PHONE Draw a simple plot plan: include property lines and proximity to lines, tanks, wells, driveways, shrubs & trees, exhaust vents, air intake, combustible sources, relevant windows and doors. In Clallam County, include septic. House Mobile Home Commercial .z . \ i , _s___,,„,-7,07/--,Al((S.-L-6 ftei444: -�� . a ' tOU . 11,0"kilet1 ( } ftk clagraucr. cat. ` Li recfro►ts ` , Circle ( V , Bwk co" --- ' riVe-- \\.___--') \ Nwyzo fIAi,/ i `e0 �� ...\777----Ns\ rzoogi �f/fit' -D/, .6 ckfi/ — / or �1os5/Y'� Cll7i✓. Jo Description: 1-0 ��5/''�`' �t/ ; =t' :. �� �I/����'`rGr - JEFFERSON COUNTY COMM•Y DEVELOPMENT,621 SHERIDAN ST,PORT TO•END WA 98368 PH: (360)379-4450 INSTALLATION PERMIT APPLICATION 4 MARK ALL ITEMS BELOW THAT PERTAIN TOK THIS INSTALLATION Underground PROPANE TANK* Above Ground PROPANE TANK* HEAT STOVE HOT WATER TANK WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE OTHER(Please Specify) & i p` Is this appliance (htg stove, hot water tank,furnace, etc.) to be installed in a Manufactured/Mobile Home? YES NO SITE ADDRESS(911 #/Road Name): �� fo 1/0 low- a-r 0 G4.3YLJ"4Lifo ij . ZIP 9 62 6 Si 9 DIGIT PARCEL ID NUMBER 00( 9 kt 00 7 Legal Description: Subdivision Name Block Lot(s) Section Township North, Range WM APPLICANT Drk.e-t 010 0 1 Scb PHONE MAILING ADDRESS 6(L -0 ( G.(L1✓eb- - ; 1` ( _ �b 14)10 ZIP 1 �3 �o1 PROPERTY OWNER ()Li c-Pne j PHONE MAILING ADDRESS 5 (� ZIP CONTRACTOR �Sf(I NC `? 20pfk.r1 C PHONE 3$S S 7 7 7 MAILING ADDRESS t°85 3 i21i ok.i Or Port- 1-12.4 Lo r W . ZIP g833S STATE LICENSE# Skins 44 P O77 Q( EXP.DATE I O y FEDERAL I.D.# I - I O 11 8S 7 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 or structure shall be requested and shall occur during regular business hours. APPLICANTS SIGNATURE I/')'YM»- DATE ( / 2- / o y FOR OFFICE USE ONLY BASE FEE $47.00 RECEIPT# k 7D6 C2/ CONSISTENCY REVIEW r01-3 p CASH/CK# rI 1 TOTAL i() •C.) DATE 01 lc o/0' 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 G:\PermitCenter\FORMS\BLDG FORMS\install-revised 10-30-03.DOC