HomeMy WebLinkAboutBLD2004-00090 •
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 #: BLD04-00090 Received Date 2/17/2004
SITE ADDRESS: 91 CAMANO LN Issue Date 2/17/2004
PORT LUDLOW, 98365
APPLICANT: ARTHUR Y KOBAYASHI PHONE:
91 CAMANO LN
PORT LUDLOW WA 983659627
44
SUBDIVISION: PORT LUDLOW NO. 2 Block: Lot:
PARCEL NUMBER: 990600244 Section: 9 Township: 28N Range: 01 E
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2004
OWNER, ARTHUR Y KOBAYASHI PHONE:
if different: 91 CAMANO LN
PORT LUDLOW WA 983659627
PROJECT DESCRIPTION: No MLA REQ'D Gas Fireplace
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 02/17/2005.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[ FinalApproval:,crat/( 0Z o2 S }e
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
UILDING PERMIT APPLIC•ON B RD04 00090
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00090 Received Date: 2/17/2004
SITE ADDRESS: 91 CAMANO LN
PORT LUDLOW, 98365
OWNER: ARTHUR Y KOBAYASHI PHONE:
91 CAMANO LN
PORT LUDLOW WA 983659627
SUBDIVISION: PORT LUDLOW NO. 2 Block: Lot: 44
PARCEL NUMBER: 990600244 Section: 9 Township: 28 N Range: 01 E
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP No MLA REQ'D Gas Fireplace
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 CJZ 02/17/04 62571
Total: $48.00
JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNSEND WA 9836§ PH.,(364)37..g-4450
L.:
` i� i
•TALLATION PERMIT APPLICATION U, L t - =- Lr
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
.---> vJ i,'2 G. i t� U fEB 1 7 2004
Underground PROPANE TANK* Above Ground PROPANE TANK* SIZE OF PROPANE TANK_
HEAT STOVE HOT WATER TANK WOODSTOVE FIREPLACE INSERT PELLET STOVE
COOKING STOVE OTHER(Please Specify) L 0 Ca 0 - .---4.,, c-, & n '.A f OpNic`+
Is this appliance(woodstove, htg stove, hot water tank,furnace,etc.)to be installed in a Manufactured/Mobile A
Home?
YES NO )_i t)
SITE ADDRESS(911#/Road Name): )2(1
/ ( . /-4a.1,,,J ZIP `l 0 3‘J^
9 DIGIT PARCEL ID NUMBER 9 gt-) 6 Q 0 2 / 7
Legal Description:
Subdivision Name Block Lot(s)
Section
Township North, Range WM
APPLICANT C/1tif tir KU J/dr,j af h !, PHONE /3 7 — 0/ d 51
MAILING ADDRESS 1/ CAI-1/ 1 J Lh p i/
P/ Li.4.49 L-ot,/ t ,.1 / O ig ZIP I-
PROPERTY OWNER _e-.-e r� PHONE
MAILING ADDRESS
n ZIP
CONTRACTOR .,, /'/W�'J elfff-�_ PHONE
MAILING ADDRESS /b g'S3 12h-e /J r
(..../ �- ZIP Cr.1-3
STATE LICENSE# 4,54-#1 J//pS-O 77 Q A EXP.DATE ///d y
FEDERALI.D.# ! ( /Q77di 7
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
inactions. Access and right of entry to the applicant's prop y or structure shall be requested and shall occur during regular business hours.
AP P�ICANTS SIGNATUREDA
DATE II a' / d y
FOR OFFICE USE ONLY
BASE FEE $48.00 RECEIPT# 103511
CONSISTENCY REVIEW __y CASH/CK# g161d
•
TOTAL 71 O ec)
* DATE a /0 /�°�
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. 4 4
G:\PermitCenter\FORMS\BLDG FORMS\install-revised 01-26-04.DOC