HomeMy WebLinkAboutBLD2004-00082 IDICILDING PERMIT APPLICAT�N B RD04 00w 082
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00082 Received Date: 2/11/2004
SITE ADDRESS: 111 E CEDAR ST
PORT LUDLOW, 98365
OWNER: WINIFRED M LORD PHONE:
111 E CEDAR ST
PORT LUDLOW WA 983658769
SUBDIVISION: PARADISE BAY ESTATES Block: 4 Lot: 20-21
PARCEL NUMBER: 983400417 Section: 23 Township: 28 N Range: 01 E
CONTRACTOR: SUBURBAN PROPANE PHONE: 385-5096
P 0 BOX 989
PORT TOWNSEND WA 98368
Contractor's License SUBURPL044DA Expires 3/12/2005
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP PROPANE HEAT STOVE AND PROPANE LINE EXTENSION
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: tn F&W Landslide
(T' �� Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid Bv: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 PRB 02/11/04 62651
Total: $48.00
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PROPANE/PELLET/WOOD STOVE & TANK INSTALLATION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD04-00082 Received Date 2/11/2004
SITE ADDRESS: 111 E CEDAR ST Issue Date 2/11/2004
PORT LUDLOW, 98365
APPLICANT: WINIFRED M LORD PHONE:
111 E CEDAR ST
PORT LUDLOW WA 983658769
20-21
SUBDIVISION: PARADISE BAY ESTATES Block: 4 Lot:
PARCEL NUMBER: 983400417 Section: 23 Township: 28N Range: 01E
CONTRACTOR: SUBURBAN PROPANE PHONE: 385-5096
P 0 BOX 989
PORT TOWNSEND WA 98368
Contractor's License SUBURPL044DA Expires 3/12/2005
OWNER, WINIFRED M LORD PHONE:
if different: 111 E CEDAR ST
PORT LUDLOW WA 983658769
PROJECT DESCRIPTION: PROPANE HEAT STOVE AND PROPANE LINE EXTENSION
THIS PERMIT IS VALID FOR ONE YEAR AND IS NOT RENEWABLE.
THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR.
THE EXPIRATION DATE IS 2/11/2005.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: ,QS /AXE= a< 274; f# �AS �rov6 .O( .0,1/5,
[ ] FinalApproval: L7 41rta.4 3/395
BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS.
Office Hours 9:00 a.m. -4:30 p.m.
HOT LINE AVAILABLE 24 HOURS A DAY
I:\F_BLD_Permit_Propane.rpt 10/29/19
JEFFERSON COUNTY COMMUNIT•VELOPMENT,621 SHERIDAN ST,PORT TOWNSA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION /HEAT
Underground PROPANE TANK* Above Ground PROPANE TANK* STOVE HOT WATER TANK
WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE
OTHER(Please Specify) Pi2Q Pam) C,t fJ -C t #3 Si O NG
Is this appliance (htg stove, hot water tank,furnace, etc.)to be installed in a Marturactured/Mobile Nome?
YES NO
SITE ADDRESS(911#/Road Name):
/1/ • Cedar St•
P6 Kt" /Lid(ovu , WA- ZIP U36 S
9 DIGIT PARCEL ID NUMBER a$ 3 1100 `/17
Legal Description:
Subdivision Name Paradise /3a y Es-fafes Block 4 Lot(s) Zo a 2
Section Township North, Range WM
APPLICANT PAM Av de4scfv) PHONE 360 - 43 7-.2 7�7
MAILING ADDRESS /'1 6"• Ceeka-r St•
Pt . Lud Co IA) 1 WA- ZIP g836,5*
PROPERTY OWNER Sam)._ PHONE
MAILING ADDRESS
J 2'1 V.ex)i 1Z ZIP
CONTRACTOR 644/1,&7.4-.p.. f rO12eA 4 L. PHONE 3g7— 0 1�,-p b
MAILING ADDRESS
ØEPA ZIP
STATELICENSE# 5O ) PL.--.. EXP.DATEFEDERAL ID.# (((
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 structure shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE a7M-vt4.— DATE d)'Z/ f I / 64(
FOR OFFICE USE ONLY ,,� , _.
BASE FEE $48.00 RECEIPT# �s%�1 l ,_ t�'C
CONSISTENCY REVIEW 4.00 CASH/CK#
TOTAL rL DATE 7 .l It / C
ZE
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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