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Home My WebLink AboutBLD2004-00101 BLD04-00101 UILDING PERMIT APPLICAON Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD04-00101 Received Date: 2/18/2004 SITE ADDRESS: 281 BLUEBERRY HILL RD PORT LUDLOW, 98365 OWNER: FRANK E MC DONALD PHONE: 261 BLUEBERRY HILL RD PORT LUDLOW WA 983658766 SUBDIVISION: Block: Lot: TX 53 PARCEL NUMBER: 821334054 Section: 33 Township: 28 N Range: 01 E CONTRACTOR: HERITAGE FIREPLACE SHOP PHONE: 19410 VIKING AVAE POULSBO WA 98370 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI NO MLA REQ'D /Above ground 250 gallon 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 Shoreline Aquifer Forest: Commercial Rural Type Amount Paid Bv: Date: Receipt: Approved/Date Propane Tanks/Stoves $48.00 CJZ 02/18/04 62574 Total: $48.00 r JEFFERSON COUNTY COMMUPDEVELOPMENT,621 SHERIDAN ST,PORT TOWD WA 98368 PH: (360)379-4450 INSTALLATION PERMIT APPLICATION MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION Underground PROPANE TANK* X 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/Mobile Home? X' YES - NO SITE ADDRESS(911#/Road Name): a g 1 6/Jr— -y /- f 7/ r'd J DI�T ud low Li . dd ZIP .7vi 36ar► 9 DIGIT PARCEL ID NUMBER V 2 13 3 . f�S4 Legal Description:Subdivision Name S01 /4f�C J I F.� 0 ,fA o' O-L4//g. Block 04,4d iAldjret" Lot(s) S-3 Section 3,3 Township N North, Range 0 / E WM APPLICANT ithOti -3- 6'UhlzlspIIc, 0 t,PHONE 3D !' 43 " ,S"-c>S`? MAILING ADDRESS n2 g E t2 I Jt b`'iy �l/! gelpG >f 9/Z-i- L, 1fl k.t)A ZIP !Q 3to s' PROPERTY OWNER ,�/L L 91'1K. % Ca 10Ow9/dj - 'S eef PHONE 3(9 0 " 43 7 - -COS. 7 MAILING ADDRESS A!ti 16104 yb i� h!Yl,zy ,'d Poiz'/ I to w ZIP '9*6 3 6 s— CONTRACTOR �-�� / c ,c/ �i %r� ��C ,/- /,'„ ., PHONE (4.' 0 ) > ? �j 3 O rip �j MAILING ADDRESS 9 5f(� ' (/ / k cS`/ Gc)e-, A`C�} (Ou (S �-iO L4 7 1` �7 ZIP STATE LICENSE# /'7 R-� / A-5 /3 /' ({ C ///2/¢;(c/ EXP.DATE FEDERAL I.D.# ( /-^ / 2'' j % / 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 r structure sh I be requested and shall occur during regular business hours. APPLICANTS SIGNATURE L --/ - FOR .�'72/ DATE •� / // / �. •T" FOR OFFI USE ONLY BASE FEE $48.00 RECEIPT# I_ +K CONSISTENCY REVIEW $24.00 SH/CK# 31030 TOTAL D O D (� ( !) 11,1 :,. Cry ./�/j / o�' . , TE +f o0 M ' i ' .I Propane Tank applications require additional informati• o :submitted. I VER Please contact our office at 360-379-4450 if the back of thi pi Catio arl. I � 1 4_.....:.... ...... ..J uePT. OF CryA4 RM�c_ r jEVELOPML T G:\PermitCenter\FORMS\BLDG FORMS\install-revised 10-30-03.DOC S 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 #: BLD04-00101 Received Date 2/18/2004 SITE ADDRESS: 281 BLUEBERRY HILL RD Issue Date 2/18/2004 PORT LUDLOW, 98365 APPLICANT: FRANK E MC DONALD PHONE: 261 BLUEBERRY HILL RD PORT LUDLOW WA 983658766 TX 53 SUBDIVISION: Block: Lot: PARCEL NUMBER: 821334054 Section: 33 Township: 28N Range: 01 E CONTRACTOR: HERITAGE FIREPLACE SHOP PHONE: 19410 VIKING AVAE POULSBO WA 98370 OWNER, FRANK E MC DONALD PHONE: if different: 261 BLUEBERRY HILL RD PORT LUDLOW WA 983658766 PROJECT DESCRIPTION: NO MLA REQ'D/Above ground 250 gallon 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 02/18/2005. REQUIRED INSPECTIONS: [ ] Tank/Line/Appliance: �NA -Pi2dpigi(!c ix.`c:.`. 2/9/ ,. [ ] FinalApproval: C 'zz: BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS. 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