HomeMy WebLinkAboutBLD2004-00056 •
BLD04-00056
BUILDING PERMIT APPLICION Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00056 Received Date: 1/30/2004
SITE ADDRESS: 11 TRADER LN
PORT LUDLOW, 98365
OWNER: WILLIAM H STEVENS III TR PHONE:
BETTY J STEVENS TRUSTEE
11 TRADER LN
PORT LUDLOW WA 983659638
SUBDIVISION: PORT LUDLOW#2 AREA 3 Block: Lot:
PARCEL NUMBER: 990603180 Section: 9 Township: 28 N Range: 01 E
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 PROPANE TANK AND COOK STOVE INSTALLATION
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 PRB 01/29/04 62528
Total: $48.00
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 #: BLD04-00056 Received Date 1/30/2004
SITE ADDRESS: 11 TRADER LN Issue Date 1/30/2004
PORT LUDLOW, 98365
APPLICANT: WILLIAM H STEVENS III TR PHONE:
BETTY J STEVENS TRUSTEE
11 TRADER LN
PORT LUDLOW WA 983659638
SUBDIVISION: PORT LUDLOW#2 AREA 3 Block: Lot:
PARCEL NUMBER: 990603180 Section: 9 Township: 28N Range: 01 E
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTP198306 Expires 9/26/2004
OWNER, WILLIAM H STEVENS III TR PHONE:
if different: BETTY J STEVENS TRUSTEE
11 TRADER LN
PORT LUDLOW WA 983659638
PROJECT DESCRIPTION: PROPANE TANK AND COOK STOVE 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:
[ ] /Lin= -pplian Z 6 A
[ ] inalAppro I: 4, O D Ø/st"
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
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* Above Ground PROPANE TANK* HEAT STOVE HOT WATER TANK
�WOODSTOVE FIREPLACE INSERT PELLET STOVE V',COOKING STOVE •
VOTHER(Please Specify) — 7&AP) C JboPief-S 9 p O
Is this appliance (htg stove, hot water tank,furnace,etc.)to be installed in a Manufactured/Mobile Home? j
YES.7 ; ✓ NO
SITE ADDRESS(911#/Road Name):
1) TrAdec )-r) •
Po r / /-v7 / 1n/ ZIP 9 Q 3 6
9 DIGIT PARCEL ID NUMBER 7 90 - 603 "
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT IYI D H h T c?)f�1 PCD f9/7e7 PHONE 3 SAS- 6 ss-3
MAILING ADDRESS a )
-es- C-,h.l h/Q OC 17 fry) JC 6l" •
Port iQQ' G ZIP 9S 335
PROPERTY OWNER g.%1 .S 7t°yen S PHONE 9 37 - 7
MAILING ADDRESS )) Try der f Lh Pert )-wel Iv ZIP 7 p
S 36S
CONTRACTOR S 9 1h r PHONE
MAILING ADDRESS
y-pL,�_ �, ZIP
�STATE LICENSE# O 17 i / p 9 30/ 9 EXP.DATE - -a 9
FEDERAL I.D.# LI I - US�6S�
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 ap nt's property or structure be requested and shall occur during regular business hours.APPLICANTS SIGNATURE DATE ) / a-g/ d y
FOR OFFICE USE ONLY
BASE FEE $49.00 RECEIPT#
CONSISTENCY REVIEW 21+490 A.4 �S'3
CASH/CK# y�¢�(,�
TOTAL 7Z -00 DATE
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
All Propa.Tank Application Requirients
When applying for a permit to install a propane tank you must submit the following:
1. Site plan showing all of the buildings, all property lines, tank location, distances from the
propane tank to all property lines and buildings, septic system components including the
reserve area. Indicate the size of the tank and whether or not it is above ground or below
ground.
2. An additional fee of$23.50 for Consistency Review is required. The total amount due at time
of application is $70.50.
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G:\PermitCenter\FORMS\BLDG FORMS\install-revised 10-30-03.DOC