HomeMy WebLinkAboutBLD2004-00079 BUILDING PERMIT APPLI TION BLD96-00140
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00079 Received Date: 2/10/2004
SITE ADDRESS: 605 OLYMPIC RIDGE DR
PORT LUDLOW, 98365
OWNER: LAWRENCE S KROTZER PHONE: 360-437-1055
605 OLYMPIC RIDGE DR
PORT LUDLOW WA 98385
SUBDIVISION: OLYMPIC RIDGE ESTATES Block: Lot: 16
PARCEL NUMBER: 821355052 Section: 35 Township: 28 N Range: 01 E
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTP1983O6 Expires 09/26/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOF 500 GAL UNDERGROUND PROPANE TANK
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:
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
�i�` t toy ! Shoreline Aquifer
/ Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 ZAN 02/10/04 62613
Total: $48.00
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 #: BLD04-00079 Received Date 2/10/2004
SITE ADDRESS: 605 OLYMPIC RIDGE DR Issue Date 2/11/2004
PORT LUDLOW, 98365
APPLICANT: LAWRENCE S KROTZER PHONE: 360-437-1055
605 OLYMPIC RIDGE DR
PORT LUDLOW WA 98385
16
SUBDIVISION: OLYMPIC RIDGE ESTATES Block: Lot:
PARCEL NUMBER: 821355052 Section: 35 Township: 28N Range: 01 E
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPI983O6 Expires 09/26/2004
OWNER, LAWRENCE S KROTZER PHONE: 360-437-1055
if different: 605 OLYMPIC RIDGE DR
PORT LUDLOW WA 98385
PROJECT DESCRIPTION: 500 GAL UNDERGROUND PROPANE TANK
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 02/11/2005.
REQUIRED INSPECTIONS:
69[ ] Tank/Line/Appliance: We. FubPA --TANIL 0 K 7/ /0 yz
p, ,
[ ] FinalApproval: ! /�, -j e,-- 4)..rt,a.•lj
191e6. -1,
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 COMMA,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
�,- , �.l
X Underground PROPANE TANK* Above Ground PROPANE TANK* SIZE OF PROPANE TANK ` f�
HEAT STOVE HOT WATER TANK 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 NO
SITE ADDRESS(911#/Road Name):
/.r+ f
6.
y' r"c-- \g,d7c, A---‘fife____.
f.�. L- 10 1.,,,, t_� ZIP ,�G-s_
9 DIGIT PARCEL ID NUMBER 2 l 3S3'' 0✓v
Legal Description: �� ��. J j ` jM
Subdivision Name x„n city 6 G:;o 1 Block Lot(s)
Section ^ Township North, Range / WM
APPLICANT a(A,/rE*,(6, , .) y
L , / .</'rU1-Z C:N~ PHONE 30 ,J 7 7
MAILING ADDRESS (7 C/.5— C/i y Yv-V/t rC fad 0'r-,�/'i%�i,
.0�- L�jLiad,✓ / [ (,✓/Q ZIP 67 3G.S
PROPERTY OWNER PHONE
MAILING ADDRESS SGt i''''e.
ZIP
CONTRACTOR / /`///)i.a 31 4-61.l.� raU/d 1 C PHONE 360 „) - s 6 a-
r
MAILING ADDRESS 2 66 C Ga'!M Lac(...,/i1Y A`- j V
Y �• ,-,te}( d k L✓/1 ZIP l�
STATE LICENSE# / ' J (AAN.1 i p_ 9 d 3o tl EXP.DATE j 2�,/O
FEDERAL I.D.# '/ `� . j
2 O � L' 5-1C
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 propertyor structure shall be requested and shall occur during regular business hours. /'
APPLICANTS SIGNATURE _ / /( "" (- -► DATE 2 / Gt� i C!
FOR OFFICE USE ONLY �� � J
�}
Q
BASE FEE $48.00 RECEIPT# ,
CONSISTENCY REVIEW $24.00 CASH/CK# ISt / 0
TOTAL 702 I'
DATE 2--//0 / V
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
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