HomeMy WebLinkAboutBLD2004-00138 • I
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 #: BLD04-00138 Received Date 3/9/2004
SITE ADDRESS: 770 N JACOB MILLER RD Issue Date 3/9/2004
PORT TOWNSEND, 98368
APPLICANT: WILLIAM T BRAYTON PHONE:
2023 E SIMS WAY#199
PORT TOWNSEND WA 98368
1-8
SUBDIVISION: TIBBALS LAKE PARK Block: 60 Lot:
PARCEL NUMBER: 999006001 Section: 32 Township: 31N Range: 01W
CONTRACTOR:
OWNER, WILLIAM T BRAYTON PHONE:
if different: 2023 E SIMS WAY#199
PORT TOWNSEND WA 98368
PROJECT DESCRIPTION: NO MLA REQ'D -ABOVE GROUND 500 GAL PROPANE TANK
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 03/09/2005.
REQUIRED INSPECTIONS:
[ ] Tank/Line Appliance4.G/4<e1-' /t
_ FinalApproval: # ///
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 10/29/19f
*BUILDING PERMIT APPLIC ON BL v
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Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00138 Received Date: 3/9/2004
SITE ADDRESS: 770 N JACOB MILLER RD
PORT TOWNSEND, 98368
OWNER: WILLIAM T BRAYTON PHONE:
2023 E SIMS WAY#199
PORT TOWNSEND WA 98368
SUBDIVISION: TIBBALS LAKE PARK Block: 60 Lot: 1-8
PARCEL NUMBER: 999006001 Section: 32 Township: 31 N Range: 01 W
CONTRACTOR: PHONE:
PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP NO MLA REQ'D -ABOVE GROUND 500 GAL PROPANE TANK
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: 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 Bv: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 CJZ 03/09/04 64053
Total: $48.00
JEFFERSON COUNTY COMMUNdEVELOPMENT,621 SHERIDAN ST,PORT TOWN.WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION Underground PROPANE TANK* ./< Above Ground PROPANE TANK* SIZE OF PROPANE TANK 5 i(�, yahl j
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
SITE ADDRESS(911#-�/Road Name): / i] p��
t770-IV c)G. ('E�h M: ``C� j2A
114,4 k41 t111 ZIP 34
'5?
9 DIGIT PARCEL ID NUMBER 16(9 00 Io OD
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT k- PHONE %b 30 I — ( oq 3
MAILING ADDRESS P ID ,A• 41-2--(42
I Z}Id.�l lt� ZIP 3k
PROPERTY OWNER PHONE
MAILING ADDRESS
ZIP
CONTRACTOR Ce '' ;4 PHONE
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 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 Jeffe son 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 t plicant's pert or structure shall be requested and shall occur during regular business hours. �J
APPLICANTS SIGNATURE / DATE 3 / J / OCI
FOR OFFICE USE ONLY
BASE FEE $48.00 RECEIPT# 105 3
CONSISTENCY REVIEW $24.00 CASH/CK# 1003
TOTAL '7 a )I DATE 3 /2 /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 Prop Tank Application Requ•ments
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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G:\PermitCenter\FORMS\BLDG FORMS\install-revised 01-26-04.DOC