HomeMy WebLinkAboutBLD2004-00052 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 #: BLD04-00052 Received Date 1/30/2004
SITE ADDRESS: 221 KENNEDY RD Issue Date 1/30/2004
PORT HADLOCK, 98339
APPLICANT: MICHELLE C NOCK PHONE:
PATRICIA A MCLAUGHLIN
221 KENNEDY RD
PORT HADLOCK WA 98339
SUBDIVISION: HESSIAN GARDENS Block: Lot:
PARCEL NUMBER: 959100110 Section: 3 Township: 29N Range: 01W
CONTRACTOR: EVERWARM INC PHONE: 800-750-7868
257151 HWY 101
PORT ANGELES WA 98362
Contractor's License EVERWI*088NL Expires 08/17/2004
OWNER, MICHELLE C NOCK PHONE:
if different: PATRICIA A MCLAUGHLIN
221 KENNEDY RD
PORT HADLOCK WA 98339
PROJECT DESCRIPTION: WOODSTOVE
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 01/30/2005.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[N( FinalApproval: O0t,4QL-L
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
• 0.
BLD04-00052
BUILDING PERMIT APPLICION Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00052 Received Date: 1/30/2004
SITE ADDRESS: 221 KENNEDY RD
PORT HADLOCK, 98339
OWNER: MICHELLE C NOCK PHONE:
PATRICIA A MCLAUGHLIN
221 KENNEDY RD
PORT HADLOCK WA 98339
SUBDIVISION: HESSIAN GARDENS Block: Lot:
PARCEL NUMBER: 959100110 Section: 3 Township: 29 N Range: 01 W
CONTRACTOR: EVERWARM INC PHONE: 800-750-7868
257151 HWY 101
PORT ANGELES WA 98362
Contractor's License EVERWI*088NL Expires 08/17/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP WOODSTOVE
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:
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:
I�3dIOL(
F&W Landslide
Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 ZAN 01/30/04 62443
Total: $48.00
WFFERSONCOUNTY COMM Y DEVELOPMENT,621 SHERIDAN ST,PORT TO ND WA 98368 PH: (360)379-4450
r
INSTALLATION PERMIT APPLICATI N
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* Above Ground PROPANE TANK* SIZE OF PROPANE TANK
HEAT STOVE HOT WATER TANK X WOODSTOVE FIREPLACE INSERT PELLET STOVE
COOKING STOVE OTHER(Please Specify)
Is this appliance(woodstove, htg stove, hot water tank,furnace,etc.)to be installed in a Manufactured/Mobile
Home?
_YES X' NO
SITE ADDRESS(911#/Road Name):
1 (- r\1')ec .1 ..
PDC t tOC k— LA2A- ZIP 9 3 3 l
9 DIGIT PARCEL ID NUMBER q l'I i 6 0 Up,
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT C Y\rl S-hat o CV, PHONE
MAILING ADDRESS (k.P1 C aS (R6c'V'r
ZIP
PROPERTY OWNER S 0..IY\N PHONE
MAILING ADDRESS
ZIP
CONTRACTOR C v(t( WaxfY) ire,,t'�,{ ( Q ct.p'-{-'(\!1 PHONE
1
MAILING ADDRESS cl b I/ ts t 111 1'V t
�c(.'y- `� ] ovzk i - w 9 ZIP 3 Z
STATE LICENSE# E V i R i I * 0 gj, g 1--- EXP.DATE 0 - I ' b LI
FEDERAL I.D.# q i i ,, Li O - y L V
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 Jefferso ounty 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 appllii tructur all be requested and shall occur during regular business hours.
nt's pe
APPLICANTS SIGNATURE /1' ( . '� ( h DATE / /c.,2 7 / r"-/
FOR OFFICE USE ONLY '' 11�
BASE FEE $48.00 RECEIPT# a4-t`i/ 3
CONSISTENCY REVIEW CASH/CK# 1 l 5
TOTAL !�" gf 00
DATE i /30 / 0k
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 01-26-04.DOC