HomeMy WebLinkAboutBLD2004-00098 411A
UILDING PERMIT APPLICA!ON B Review Type:
y pe:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00098 Received Date: 2/17/2004
SITE ADDRESS: 4455 SR20
PORT TOWNSEND, 98368
OWNER: GEORGE NAKANO PHONE:
PO BOX 98
CHIMACUM WA 983250098
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 901081008 Section: 8 Township: 29 N Range: 01 W
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 INSTALLATION
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:
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 02/17/04 62656
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 #: BLD04-00098 Received Date 2/17/2004
SITE ADDRESS: 4455 SR20 Issue Date 2/18/2004
PORT TOWNSEND, 98368
APPLICANT: GEORGE NAKANO PHONE:
PO BOX 98
CHIMACUM WA 983250098
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 901081008 Section: 8 Township: 29N Range: 01W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTP198306 Expires 9/26/2004
OWNER, GEORGE NAKANO PHONE:
if different: PO BOX 98
CHIMACUM WA 983250098
PROJECT DESCRIPTION: PROPANE TANK 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 2/18/2005.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[ ] FinalApproval:Thr1X L ,3 ®y
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
- r JEFFERSON COUNTY COMMUNI ' EVELOPMENT,621 SHERIDAN ST,PORT TOWN WA 98368 PH: (360)379-4450
STALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* Above Ground PROPANE TANK* SIZE OF PROPANE TANK l a"e7
_ntAT STOVE HOT WATER TANK WOODSTOVE I 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 1/ NO
SITE ADDRESS(911#/Road Name):
'4 J#53 d)►.tr
?orf low hS ts,0/ ZIP ;/ F536
9 DIGIT PARCEL ID NUMBER 9 t
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT Mountain Propane PHONE 3 5v 6 SS 3
265 Chiiiacum Rd.
MAILING ADDRESS Port HadiGnic, cr,339
ZIP
PROPERTY OWNER L-O/S /AA'? Q knD PHONE 3 65 33 S?—
MAILING ADDRESS P'0 7 f ) O)( 9 Q
ChJ/n Cti)1 , w,4- ZIP %g3
CONTRACTOR Mountain Propane PHONE 3 " 6 g g 3
265 Chimacum Rd.
MAILING ADDRESS Port Hadlock, WA 9b339
7- ZIP
STATE LICENSE# /YJO h 4/T P 9.6306 EXP.DATE g c2Z5
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 a
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 an)
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 late
inspections. Access and right of entry to th applicant's property or structure shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE DATE / .l / 0
FOR OFFICE USE ONLY ,,
BASE FEE $48.00 RECEIPT# ( 214, )
CONSISTENCY REVIEW $24.00 CASH/CK# - 1 ^1 �?
TOTAL 7Z-.COO DATE / 7 / (,�� I
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