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HomeMy WebLinkAboutBLD2004-00055 • 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 #: BLD04-00055 Received Date 1/30/2004 SITE ADDRESS: 1481 BLACK POINT RD Issue Date 1/30/2004 BRINNON, 98320 APPLICANT: LARRY T HOWLAND TRSTEE PHONE: CONSTANCE R HOWLAND TRSTE 263 OLD OAK BAY RD PORT HADLOCK WA 983399734 SUBDIVISION: Block: Lot: PARCEL NUMBER: 502143002 Section: 14 Township: 25N Range: 02W CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTPI98306 Expires 9/26/2004 OWNER, LARRY T HOWLAND TRSTEE PHONE: if different: CONSTANCE R HOWLAND TRSTE 263 OLD OAK BAY RD PORT HADLOCK WA 983399734 PROJECT DESCRIPTION: PROPANE TANK INSTALLATION 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 1/30/2005. REQUIRED INSPECTIONS: [ ] far /Line4d•• ,•--: Z.we 2/0/0 fyi/ s,4e,4pt# siYvg' .W [ ] inalAproval) OA D z�O4•J1 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 • BLD04-00055 BUILDING PERMIT APPLIC ION Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD04-00055 Received Date: 1/30/2004 SITE ADDRESS: 1481 BLACK POINT RD BRINNON, 98320 OWNER: LARRY T HOWLAND TRSTEE PHONE: CONSTANCE R HOWLAND TRSTE 263 OLD OAK BAY RD PORT HADLOCK WA 983399734 SUBDIVISION: Block: Lot: PARCEL NUMBER: 502143002 Section: 14 Township: 25 N Range: 02 W CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTPI983O6 Expires 9/26/2004 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOt PROPANE TANK INSTALLATION TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 1997 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: 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 Propane Tanks/Stoves $48.00 PRB 01/30/04 62530 Total: $48.00 JEFFERSON COUNTY COMMOY 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* X Above Ground PROPANE TANK* x 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 Maialliictaideae.ile Home? YES . NO SITE ADDRESS(911#/Road Name): _\ t \ 6\ Ckl" • itSC\INsc)0� �,�y ZIP Csalg•� 9 DIGIT PARCEL ID NUMBER S 2" \ 's©tr..' Legal Description: Subdivision Name cat,sm.-V Lot(1s) 3 Section �� Township 25 North, Range 2•NrYLS"\ WM APPLICANT t.Z`( \\'Ow`v''a• PHONE 'WO-1r1�- t\Rt8 MAILING ADDRESS P.o•itte` t% `t1'i\tiN1 ZIP (11COP-24 PROPERTY OWNER SZM�.. PHONE MAILING ADDRESS ZIP CONTRACTOR `MO 2^(V1 PHONE 3$5^ ( %'b) MAILING ADDRESS 2c„5 d\t.N•tKN't,\V ,C) cr ZIP ais3'8'N 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 the applicant's property or struct shall be requested and shall occur during regular business hours. APPLICANTS SIGNATURE d\S).S.% DATE / /40%) N FOR OFFICE USE ONLY BASE FEE $48.00 RECEIPT# k_C 720 CONSISTENCY REVIEW $24.00 CASH/CK# C1 TOTAL 1Z'00 DATE / / 054 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. 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