HomeMy WebLinkAboutBLD2004-00085 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 #: BLD04-00085 Received Date 2/13/2004
SITE ADDRESS: 132 NIP LEE RD Issue Date 2/13/2004
CHIMACUM, 98325
APPLICANT: MICHAEL K GALMUKOFF PHONE:
RENEE L GALMUKOFF
PO BOX 157
CHIMACUM WA 983250157 1
SUBDIVISION: COLLINS SHORT PLAT Block: Lot:
PARCEL NUMBER: 901112024 Section: 11 Township: 29N Range: 01W
CONTRACTOR:
OWNER, MICHAEL K GALMUKOFF PHONE:
if different: RENEE L GALMUKOFF
PO BOX 157
CHIMACUM WA 983250157
PROJECT DESCRIPTION: NO MLA REQ"D Above ground 250 gallon Propane tank
(permitting a existing 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 02/13/2005.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[ ] Fin alApproval lit 9/1/0 �f,��
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 10/29/195.
BUILDING PERMIT APPLICfION BL Review vy085
iew T Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00085 Received Date: 2/13/2004
SITE ADDRESS: 132 NIP LEE RD
CHIMACUM, 98325
OWNER: MICHAEL K GALMUKOFF PHONE:
RENEE L GALMUKOFF
PO BOX 157
CHIMACUM WA 983250157
SUBDIVISION: COLLINS SHORT PLAT Block: Lot: 1
PARCEL NUMBER: 901112024 Section: 11 Township: 29 N Range: 01 W
CONTRACTOR: PHONE:
PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI' NO MLA REQ"D Above ground 250 gallon Propane tank (permitting a
existing 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
Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $48.00 CJZ 02/13/04 62568
Total: $48.00
JEFFERSON COUNTY COMMU'JEVELOPMENT,621 SHERIDAN ST,PORT TOWN,WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
r
Underground PROPANE TANK* Above Ground PROPANE TANK* 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 Manufactured/ obile Home?
YES NO
SITE ADDRESS(911#/Road Name):
Po:I' jJ t,J/ jz Lic - ZIP /I' 3s2
9 DIGIT PARCEL ID NUMBER O( /1 7 OA >�
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT ce f,eG fl"Q-6 PHONE C.h,8-. 3 - /'D ,f ,-
MAILING ADDRESS kip 5- , ry ,/ 11 e
SP u/` r G ZIP 7/-3 E L
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PROPERTY OWNER ! /e 6-a- / YY( GC�/"C O PHONE / _/^l 7 . 4"
MAILING ADDRESS /3 . y�A/1 /L' `e
p�f� ""' / e- /....c)u ZIP F(.,3-1-
CONTRACTOR Fe Y r z`71,_G>✓ 5 PHONE
MAILING ADDRESS
ZIP
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 t e applicant's property or struct shall requested and shall occur during regular business hours. (�
APPLICANTS SIGNATURE -�<-- c._ t.;. --- DATE r / / 0/ O 7
FOR OFFICE USE ONLY
BASE FEE $48.00 RECEIPT# 5(p 8
CONSISTENCY REVIEW $24.00 CASH/CK# C AS 4
TOTAL rl A DATE a / 13 /oZct7
t *
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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