HomeMy WebLinkAboutBLD2004-00047 •
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 #: BLD04-00047 Received Date 1/26/2004
SITE ADDRESS: 440 ADELMA BEACH RD Issue Date 1/27/2004
PORT TOWNSEND, 98368
APPLICANT: JOHN BUHLER PHONE: (360) 385-1375
JILL BUHLER
440 ADELMA BEACH RD
PORT TOWNSEND WA 98368-9280 T G-8
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 001324043 Section: 32 Township: 30N Range: 01W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPI983O6 Expires 09/26/2004
OWNER, JOHN BUHLER PHONE: (360) 385-1375
if different: JILL BUHLER
440 ADELMA BEACH RD
PORT TOWNSEND WA 98368-9280
PROJECT DESCRIPTION: ABOVE PROPANE TANK, HEAT STOVE AND 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 01/27/2005.
REQUIRED INSPECTIONS:
[LI/ Tank/Line/Appliance:a/C.„ao l 1.2—i--(:*'
[� FinalApproval: W Ge-n 9)rL l -29-o7
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 APPLIC ION BLD04-00047
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00047 Received Date: 1/26/2004
SITE ADDRESS: 440 ADELMA BEACH RD
PORT TOWNSEND, 98368
OWNER: JOHN BUHLER PHONE: (360) 385-1375
JILL BUHLER
440 ADELMA BEACH RD
PORT TOWNSEND WA 98368-9280
SUBDIVISION: Block: Lot: T G-8
PARCEL NUMBER: 001324043 Section: 32 Township: 30 N Range: 01 W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTP198306 Expires 9/26/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION ABOVE PROPANE TANK, HEAT STOVE AND PIPING
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
Propane Tanks/Stoves $48.00 KAS 01/26/04 62523
Total: $48.00
i JEFFERSON COUNTY COMMIOY DEVELOPMENT,621 SHERIDAN ST,PORT TO,END WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* X Above Ground PROPANE TANK* X HEAT STOVE HOT WATER TANK
WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE 0
p
24- OTHER(Please Specify) l i )49
Is this appliance (htg stove, hot water tank,furnace,etc.)to be installed in a Manufactured/Mobile Home?
YES IN NO
SITE ADDRESS(911#/Road Name):
CtO ".0 4- R 1 A.,,,,
_ty1---- ZIP a
9 DIGIT PARCEL ID NUMBER 7c9/ 3 may. D Y)
Legal Description:
Subdivision Name 5 3 2- T 3 0/^'1C T i( k UI Block Lot(s)
1�Section L Vs • G -vQ North, Range WM
APPLICANT c_ - tf Yu I13 Vr M L 4(� PHONE 3 �' —/ -
MAILING ADDRESS "( t( 0 A A l /+''r, Sf 4 Z /2", C
1 4—Tcsct1.90 S• 27Lti .4--3 fi ZIP i Y 3 6�
PROPERTY OWNER PHONE
MAILING ADDRESS
ZIP S - 6 S (
CONTRACTOR Mountain Propene PHONE 3 Q V Q
� 3
265 Chimacum Rd.
MAILING ADDRESS Port Hadlock, WA 98339
ZIP �*
STATE LICENSE# /n D 14 r) * P X q s 306 EXP.DATE 7 Q — -6 -0 Y
FEDERAL I.D.# yi-- aos 56 6-3"--
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 property or struct all be re ested
ested and shall occur during regular business hours. /
APPLICANTS SIGNATURE ,� . ? ° � (• DATE l �b l G C/
/ FOR OFFICE USE ONLY aa��
BASE FEE ,$48.00 RECEIPT# 6 eC 3- 3
CONSISTENCY REVIEW $24.00 CASH/CK# - GQa
TOTAL -2_, .0 d DATE / /o� 6 d 'y
*
Propane Tank applications require additional information to be submitted. —�� �4} Q` '�� �
Please contact our office at 360-379-4450 if the back of this application is blank. o, a ,r V -11
s� L 6 2004 l� ii
JAN _�
1
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