HomeMy WebLinkAboutBLD2004-00136 • •
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 #: BLD04-00136 Received Date 3/5/2004
SITE ADDRESS: 320 TALA SHORE DR Issue Date 3/5/2004
PORT LUDLOW, 98365
APPLICANT: DOUGLAS M KVINNESLAND PHONE:
2981 PARADISE BAY RD
PORT LUDLOW WA 983658739
4
SUBDIVISION: TALA SHORES#3 Block: Lot:
PARCEL NUMBER: 998200304 Section: 15 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 9/6/2004
OWNER, DOUGLAS M KVINNESLAND PHONE:
if different: 2981 PARADISE BAY RD
PORT LUDLOW WA 983658739
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 3/5/2005.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: R6IAuE /�Nk lv/tCld�oLv� 2eJr
[ ] FinalApproval: a Pad- 0 5,Z/,�
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
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UILDING PERMIT APPLICA N B Review
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00136 Received Date: 3/5/2004
SITE ADDRESS: 320 TALA SHORE DR
PORT LUDLOW, 98365
OWNER: DOUGLAS M KVINNESLAND PHONE:
2981 PARADISE BAY RD
PORT LUDLOW WA 983658739
SUBDIVISION: TALA SHORES#3 Block: Lot: 4
PARCEL NUMBER: 998200304 Section: 15 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 9/6/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION PROPANE TANK INSTALLATION
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 1997 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE SHORELINE:
GARAGE: SETBACK:
CONST TYPE: 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 Bv: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 PRB 03/05/04 62682
Total: $48.00
JEFFERSON COUNTY COMMU•DEVELOPMENT,621 SHERIDAN ST,PORT TOW D WA 98368 PH: (360)379-4450
` INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION ` SWAT C( OUT-
Underground PROPANE TANK* \ Above Ground PROPANE TANK* SIZE OF PROPANE TANK 2 D
HEAT STOVE HOT WATER TANK WOODSTOVE FIREPLACE INSERT PELLET STOVE
COOKING STOVE OTHER(Please Specify)
i
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):
2o LA St-(OQt 1C ..
Q_C ' �. V 1,o(J) ZIP q C J
9 DIGIT PARCEL ID NUMBER q ct g-2__Go. 304--
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT G'� t tO, CJ PHONE f 37- 0(2 6 /
MAILING ADDRESS .32XI AIR J �V1 00—
o (
�'tO` ( ZIP 1 “)>
PROPERTY OWNER S . PHONE
MAILING ADDRESS
ZIP
CONTRACTOR C • J + PHONE
MAILING ADDRESS
1 (� ZIP
STATE LICENSE# ON/ F t- 4 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,repres ntatives or agents for the purpose of application review and any required later
inspections. Access and right of entry to licant' pert tructure shall b PO_
a shall occur during regular business hours.
APPLICANTS SIGNATURE I( l l�'�O, DATE b l l 6 y
FOR OFFICE USE ONLY / / G
BASE FEE $48.00 RECEIPT# (OZ b0
CONSISTENCY REVIEW e $24.00/ CASH/CK# C-A3(---
TOTAL �H' ( Z•OD DATE 3 / 57. (71t
* ll"
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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