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HomeMy WebLinkAboutBLD2004-00122 • BUILDING PERMIT APPLICION BLD04-00122 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD04-00122 Received Date: 2/26/2004 SITE ADDRESS: 310 SCHWARTZ RD NORDLAND, 98358 OWNER: LISA A MOORE PHONE: PO BOX 96 NORDLAND WA 983580096 SUBDIVISION: Block: Lot: PARCEL NUMBER: 021283008 Section: 28 Township: 30 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 9/6/2004 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION 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: 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 02/26/04 62668 Total: $48.00 PROPANE/PELLET/WOOD STOVE & TANK INSTALLATION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD04-00122 Received Date 2/26/2004 SITE ADDRESS: 310 SCHWARTZ RD Issue Date 2/26/2004 NORDLAND, 98358 APPLICANT: LISA A MOORE PHONE: PO BOX 96 NORDLAND WA 983580096 SUBDIVISION: Block: Lot: PARCEL NUMBER: 021283008 Section: 28 Township: 30N Range: 01E CONTRACTOR: C H S PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/6/2004 OWNER, LISA A MOORE PHONE: if different: PO BOX 96 NORDLAND WA 983580096 PROJECT DESCRIPTION: PROPANE TANK INSTALLATION THIS PERMIT IS VALID FOR ONE YEAR AND IS NOT RENEWABLE. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 2/26/2005. REQUIRED INSPECTIONS: [ ] Tank/Line/Appliance: 44434 hoc- s$ LA«n4J'-J.tr Ok 3/7/4c [ ] FinalApproval: OK 4cl. „vta J 3/7/'5.44 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 • Si,...), ZCH AI1 , 0 165 31 WANIA Z Q 9 (L • �? 0_ cz� rn 4.. 8 e ]S(1 -<59 jc) , -� fi' S N N 0 I� r �p ft i1 (1 JEFFERSON COUNTY COMMUCDEVELOPMENT,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* SIZE OF PROPANE TANK Z S O EAT STOVE -•Ac/OT WATER TANK WOODSTOVE FIREPLACE INSERT PELLET STOVE eil 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 k NO SITE ADDRESS(911#/Road Name):s. / 1 7f / 3 f to �C X c.✓c*,cT Z Z e' al " /109.1 .eta c•-.3-fOti 2 ZIP 923r8 9 DIGIT PARCEL ID NUMBER D2/ Z Er3 ©08 Legal Description: Subdivision Name Block Lot(s) Section / Township North, Range WM APPLICANT a1/ 267-74,J PHONE .3US- 3 VEIR MAILING ADDRESS 2 O 2.►7C 7,6 Aiuio/%,...c.; C...eJ!4. ZIP 98 3 s8 PROPERTY OWNER Is S/4- �6oir—.F— PHONE 325— 3ra,= MAILING ADDRESS 2cD "7( 9:4 p` A)ox.!/0P.4J._( ZIP 4U3er8 • CONTRACTOR l L)r K P 7 , PHONE MAILING ADDRESS FEB 2 6 2004 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 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 p erty or structure shall be requested and shall occur during regular business hours. APPLICANTS SIGNATURE % . DATE .1 /2 c / a Y FOR OFFICE USE ONLY -� BASE FEE $48.00 RECEIPT# C(�jC;7 CONSISTENCY REVIEW $24.00 CASH/CK# . 07 %( TOTAL _/2 .00 DATE - —/ /6 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