HomeMy WebLinkAboutBLD2004-00114V
•BUILDING PERMIT APPLICATION BLD04-00114Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00114 Received Date: 2/24/2004
SITE ADDRESS: 440 IRONDALE RD
PORT HADLOCK, 98339
OWNER: JAMES B BASKETT PHONE:
SHARON R BASKETT
PO BOX 552
PORT HADLOCK WA 983390552
SUBDIVISION: IRONDALE Block: 1 Lot: 12-24
PARCEL NUMBER: 961800103 Section: 3 Township: 30 N Range: 01 W
CONTRACTOR: C H S PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CHSIN**9790Z Expires 9/6/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOD ABOVE GROUND PROPANE TANK INSTALLATION
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 PRB 02/24/04 62667
Total: $48.00
I
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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 #: BLD04-00114 Received Date 2/24/2004
SITE ADDRESS: 440 IRONDALE RD Issue Date 2/24/2004
PORT HADLOCK, 98339
APPLICANT: JAMES B BASKETT PHONE:
SHARON R BASKETT
PO BOX 552
PORT HADLOCK WA 983390552 12-24
SUBDIVISION: IRONDALE Block: 1 Lot:
PARCEL NUMBER: 961800103 Section: 3 Township: 30N Range: 01W
CONTRACTOR: C H S PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CHSIN**9790Z Expires 9/6/2004
OWNER, JAMES B BASKETT PHONE:
if different: SHARON R BASKETT
PO BOX 552
PORT HADLOCK WA 983390552
PROJECT DESCRIPTION: ABOVE GROUND 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 2/24/2005.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
['1" FinalApproval: a/gybf
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
JEFFERSON COUNTY COMM DEVELOPMENT,621 SHERIDAN ST,PORT TO•ND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* VAbove Ground PROPANE TANK* SIZE OF PROPANE TANK z :0
HEAT STOVE HOT WATER TANK WOODSTOVE 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 NO
SITE ADDRESS(911#/Road Name):
1-1140'' i P-oNtAL �17
Lc
me) ZIP ! 7
b 9 DIGIT PARCEL ID NUMBER q c e) Lb3
Legal Description:
Subdivision Name Block Lot(s)
Section j/ Township North, Range WM
APPLICANT ,J)9 M (L9 j ice PHONE � J
MAILING ADDRESS yyC7 (fZ Ni -
. NADiac� ZIP
PROPERTY OWNER 5 M --' PHONE
MAILING ADDRESS
ZIP
CONTRACTOR C • . S PHONE 24 ibt
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 attorneys 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 ent to the pplicant's roperty or structure shall be requested and all occur durin re r business hours.
ram'APPLICANTS SIGNATURE /4 or _ DATE / 2 t!'it' /
FOR OFFICE USE ONLY
BASE FEE $48.00 RECEIPT#
CONSISTENCY REVIEW L-if`r-
$24.00 CASH/CK# � �� `
$
TOTAL 12--00 DATE v' l 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.
G:\PermitCenter\FORMS\BLDG FORMS\install-revised 01-26-04.DOC
All Propart Tank Application Requirinents
When applying for a permit to install a propane tank you must submit the following:
1. Site plan showing all of the buildings, all property lines, tank location, distances from the
propane tank to all property lines and buildings, septic system components including the
reserve area. Indicate the size of the tank and whether or not it is above ground or below
ground.
2. An additional fee of$24.00 for Consistency Review is required. The total amount due at time
of application is $72.00.
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FORMS\install-revised 01-26-04.DOC