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Home My WebLink AboutBLD2004-00113 40 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 #: BLD04-00113 Received Date 2/24/2004 SITE ADDRESS: 4677 CENTER RD Issue Date 2/24/2004 CHIMACUM, 98325 APPLICANT: ELIZABETH A BROWN PHONE C/O TRUST ACCOUNTING CENT PO BOX 730 ANACORTES WA 982210730 SUBDIVISION: JOHNSTON SHORT PLAT Block: Lot: PARCEL NUMBER: 801034025 Section: 3 Township: 28N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2004 OWNER, ELIZABETH A BROWN PHONE if different: C/O TRUST ACCOUNTING CENT PO BOX 730 ANACORTES WA 982210730 PROJECT DESCRIPTION: 120 GALLON ABOVE GROUND PROPANE TANK AND PIPING 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 02/24/2005. REQUIRED INSPECTIONS: [ ] Tank/Line/Appliance:7 t,< VS7 [LI FinalApproval: /_S _c2( 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 APPLICAION B RD04-0011eviewe13 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD04-00113 Received Date: 2/24/2004 SITE ADDRESS: 4677 CENTER RD CHIMACUM, 98325 OWNER: ELIZABETH A BROWN PHONE: C/O TRUST ACCOUNTING CENT PO BOX 730 ANACORTES WA 982210730 SUBDIVISION: JOHNSTON SHORT PLAT Block: Lot: PARCEL NUMBER: 801034025 Section: 3 Township: 28 N Range: 01 W 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 DESCRIPTIOI' 120 GALLON ABOVE GROUND PROPANE TANK AND PIPING 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: 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 ,. _ Z4 )D ' _--Y^� Shoreline Aquifer I Forest: Commercial Rural Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $48.00 ZAN 02/24/04 62632 Total: $48.00 I JEFFERSON COUNTY COMMUNITY DEVELOPMENT.621 SHERIDAN ST.PORT TOWNSEND WA 98368 PH: (360)379-4450 IrALLATION PERMIT APPLICATIO• MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION Underground PROPANE TANK* K Above Ground PROPANE TANK* SIZE OF PROPANE TANK fa 0 j-C- HEAT STOVE HOT/WATER TANK WOODSTOVE FIREPLACE INSERT PELLET STOVE X 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 NO SITE ADDRESS(911#/Road Name): Cutz, Ni474_ez,....,` '(& 7 7 k� J 1�� . ZIP 913 0`,c-- 9 DIGIT PARCEL ID NUMBER pot 0 3 V 0 1 S Legal Description: Subdivision Name Block Lot(s) Section Township North, Range WM �iC2e ? APPLICANT /— 4/Z( (J J PHONE 73 ) // / D MAILING ADDRESS ,L7 �� ZIP PROPERTY OWNER ��// 6/Z. t.g �/Y�/ PHONE --� MAILING ADDRESS %70 2 (a.�.it" ZIP CONTRACTOR SUNSHINE PROPANE PHONE Quality Energy Services Since 1980 MAILING ADDRESS 10853 Rhody Dr. Hadlock,WA 98339 (360)385-5797 or 683-4010 www.sunshinepropane.corn ZIP STATE LICENSE# 514 n sf-E p*o 77 Q P EXP.DATE FEDERAL I.D.# . 91 - /01Cc 8 3—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 inspections. Access and right of entry to the applicant's pro rty or structure shall be requested and shall occur during regular business hours. APPLICANTS SIGNATURE (/1V DATE / ' 0 (J FOR OFFICE USE ONLY BASE FEE $48.00 (0 ) to 3 RECEIPT# u,� CONSISTENCY REVIEW $24.00 CASH/CK# () S D 5 • TOTAL DATE 2_/24 011 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 G:\PermitCenter\FORMS\BLDG FORMS\install-revised 01-26-04.DOC 1 Feb 24 04 11 : 47a Lill1 -3 -385-5875 p. 1 SITE VISIT REPORT JOB P '% ?Jr-6,d,.l`n DATE /Xi// ADDRESS BY PHONE Draw a simple plot plan: include property lines and proximity to lines, tanks, wells, driveways, shrubs & trees, exhaust vents, air intake, combustible sources, relevant windows and doors. In Ciallam County, include septic. House Mobile Home Commercial "I r _r_e_____ { Jeck 1 zeck i 10 I c ;tree ,se rind .:51.4,4-p-,,,ii,iLt/i j ' lJ/11O�' '! ---�.+ — -- 0/7 �o/,/Clete. L 6 (1741 rL•r CON(R t 73 - -- Li : L 1 c Description: ---, � " NTH . „ ly., 1p<'� ',fir '`• /i• 7.J+-' 42 ,' ,j. '"/ (C'/1''�i.' 1-<'. '1/