HomeMy WebLinkAboutBLD2004-00131 •
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 #: BLD04-00131 Received Date 3/2/2004
SITE ADDRESS: 136 BRUSH PLANT RD Issue Date 3/3/2004
QUILCENE, 98376
APPLICANT: ANDREW M PRESCOTT PHONE:
SANDRA J PRESCOTT
PO BOX 35
QUILCENE WA 983760035
SUBDIVISION: HAMILTON'S 5AC TRACTS Block: Lot:
PARCEL NUMBER: 956100043 Section: 13 Township: 27N Range: 02W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2004
OWNER, ANDREW M PRESCOTT PHONE:
if different: SANDRA J PRESCOTT
PO BOX 35
QUILCENE WA 983760035
PROJECT DESCRIPTION: ABOVE GROUND 500GAL 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 3/3/2005.
REQUIRED INSPECTIONS:
/7�
[ ] �-r�APPliance: �.)�tJ f/9ti3EC � �,1 �� t�X7EiJ tom 5 to D!� 3 q 0 7
[ ] inalApproval: ��/ �Gr b 3/ i #.0
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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
is\F_BLD_Permit_Propane.rpt 10/29/19
S •UILDING PERMIT APPLICAN B RD04 00p1e31
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00131 Received Date: 3/2/2004
SITE ADDRESS: 136 BRUSH PLANT RD
QUILCENE, 98376
OWNER: ANDREW M PRESCOTT PHONE:
SANDRA J PRESCOTT
PO BOX 35
QUILCENE WA 983760035
SUBDIVISION: HAMILTON'S 5AC TRACTS Block: Lot:
PARCEL NUMBER: 956100043 Section: 13 Township: 27 N Range: 02 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` ABOVE GROUND 500GAL 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
Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 PRB 03/02/04 62675
Total: $48.00
JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNSEND WA 98368 PH: (360)379-4450
a
IteALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* \(- Above Ground PROPANE TANK* SIZE OF PROPANE TANK So ee
HEAT STOVE HOT WATER TANK WOODSTOVEVE FIREPLACE INSERT PELLET STOVE
COOKING STOVE KOTHER(Please Specify) v 'J S P / P G
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):
3 8 2tA4 /- Pa- P--d
0IMX-co...-vl_e____` `A ZIP g P.3 7
9 DIGIT PARCEL ID NUMBER 9J t oo 0
Legal Description:
Subdivision Name Block Lot(s)
Section Township _North, Range WM
r7/ c 0/QAPPLICANT YfLQJCt( PHONE [ �PJ .
MAILING ADDRESS S{
ZIP i ,
'��/ 1
PROPERTY OWNER ",Q�'C
PHONE
MAILING ADDRESS 1 k, ,
ZIP
CONTRACTOR 3tL4fl £ pmsr kv_e..__ PHONE R
4'.' I
MAILING ADDRESS (O '53 k./.(1,9-.1 0 r .__
prr , ( a_ ZIP cU,23F
STATE LICENSE# C U h s P* D7 7 Q f EXP.DATE fl/OY
FEDERAL I.D.# `i /0 7 ,,..3
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 ap 'cant' pro rty or structure shall be req sted and hall occur during regular business hours.
APPLICANTS SIGNATURE ATE 3 l 1 1 U y
FOR OFFI -SE ONLY •BASE FEE $48.00 RECEIPT# C-.>Z.G 75_
CONSISTENCY REVIEW $24.00 CASH/CK# (f' -0 C,
•
TOTAL IBC C. "'C° DATE 3 / 2 / 31
*
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.
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