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HomeMy WebLinkAboutBLD2004-00109 116UILDING PERMIT APPLICAlON B D04-00p109 Review Ty Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD04-00109 Received Date: 2/23/2004 SITE ADDRESS: 2951 PARADISE BAY RD PORT LUDLOW, 98365 OWNER: ALLEN J BARCUS PHONE: ANN L BARCUS 2951 PARADISE BAY RD PORT LUDLOW WA 983658739 SUBDIVISION: TALA SHORES#1 Block: Lot: 18 PARCEL NUMBER: 998200116 Section: 22 Township: 28 N Range: 01 E CONTRACTOR: C H S PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 09/06/2004 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION NO MLA REQ'D -ABOVE GROUND PROPANE TANK 250 GALLON - REPLACEMENT 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 Propane Tanks/Stoves $48.00 CJZ 02/23/04 62576 Total: $48.00 410 • 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 #: BLD04-00109 Received Date 2/23/2004 SITE ADDRESS: 2951 PARADISE BAY RD Issue Date 2/23/2004 PORT LUDLOW, 98365 APPLICANT: ALLEN J BARCUS PHONE: ANN L BARCUS 2951 PARADISE BAY RD PORT LUDLOW WA 983658739 18 SUBDIVISION: TALA SHORES#1 Block: Lot: PARCEL NUMBER: 998200116 Section: 22 Township: 28N Range: 01 E CONTRACTOR: C H S PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 09/06/2004 OWNER, ALLEN J BARCUS PHONE: if different: ANN L BARCUS 2951 PARADISE BAY RD PORT LUDLOW WA 983658739 PROJECT DESCRIPTION: NO MLA REQ'D -ABOVE GROUND PROPANE TANK 250 GALLON - REPLACEMENT 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 02/23/2005. REQUIRED INSPECTIONS: [ ] Tank/Line/Appliance: ANK LSpt.A "►4c r O1( V 103 [ ] FinalApproval: C.!r 1 �or- -ct,'lai I 3t OS 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� .,ri JEFFERSON COUNTY COMMU•DEVELOPMENT,621 SHERIDAN ST,PORT TOWID WA 98368 PH: (360)379-4450 INSTALLATION PERMIT APPLICATION MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION 2 sa C4Z. 7 4AJt1 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/Mobile Home? YES NO SITE ADDRESS(911#/Road Name): 39 51 Peaa I,hsc ecw, !C poik Laltw 110 ZIP QeS [ 9 DIGIT PARCEL ID NUMBER ?9 5 2 0 c7// 6 Legal Description: qS felk pLgtRt~eoQ..OA 0 tN Volume 4 ott ps,&s PAGE z8 Subdivision Name LoT /8 ©,4 T4L14 SE{nE'S Block Lot(s) Section Township North, Range WM APPLICANT ail t A6OUW£Lflfl S PHONE 3(p O 4 3 i) 5 ) b MAILING ADDRESS a 9 5 1 1A po 1 Lu_b Lt ui1 lj& ZIP 10303 PROPERTY OWNER S 'Qs PHONE MAILING ADDRESS S' /E— ZIP CONTRACTOR t S 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 Co ty and it's employees,representatives or agents for the purpose of application review and any required later inspections. Access and right of ent e licant's propert tructure shall be requested and shall occur during regular business hours. CC APPLICANTS SIGNATURE DATE / l FOR OFFICE USE ONLY BASE FEE $48.00 RECEIPT# 51 fO Op L, CONSISTENCY REVIEW CASH/CK# A5 1T. TOTAL 0 DATE O /o"1O /anal. Propane Tank applications require additional information to be submitted. Please contact our office at 360-379-4450 if the back of this application is blank. OVER 4 4 4 G:\PermitCenter\FORMS\BLDG FORMS\install-revised 10-30-03.DOC