HomeMy WebLinkAboutBLD2004-00141 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 #: BLD04-00141 Received Date 3/10/2004
SITE ADDRESS: 51 WINDROSE PL Issue Date 3/10/2004
PORT LUDLOW, 98365
APPLICANT: LOREN G KRAGH PHONE:
NANCY F KRAGH
51 WINDROSE DR
PORT LUDLOW WA 983659799
SUBDIVISION: BAYVIEW VILLAGE DIV 1 Block: Lot:
PARCEL NUMBER: 931900022 Section: 16 Township: 28N Range: 01E
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTP198306 Expires 09/26/2004
OWNER, LOREN G KRAGH PHONE:
if different: NANCY F KRAGH
51 WINDROSE DR
PORT LUDLOW WA 983659799
PROJECT DESCRIPTION: NO MLA REQ'D -ABOVE GROUND 120 GALLON PROPANE TANK
REPLACEMENT
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 03/10/2005.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: VFPLL#614Fu?- uK OK
[ ] FinalApproval: CX -gar ��U 3/3/A
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.c
BUILDING PERMIT APPLIC ON B Review D04 00p4•
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00141 Received Date: 3/10/2004
SITE ADDRESS: 51 WINDROSE PL
PORT LUDLOW, 98365
OWNER: LOREN G KRAGH PHONE:
NANCY F KRAGH
51 WINDROSE DR
PORT LUDLOW WA 983659799
SUBDIVISION: BAYVIEW VILLAGE DIV 1 Block: Lot:
PARCEL NUMBER: 931900022 Section: 16 Township: 28 N Range: 01 E
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPI983O6 Expires 09/26/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOF NO MLA REQ'D -ABOVE GROUND 120 GALLON PROPANE TANK
REPLACEMENT
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 CJZ 03/10/04 64060
Total: $48.00
JEFFERSON COUNTY COMMUtDEVELOPMENT,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* K Above Ground PROPANE TANK* SIZE OF PROPANE TANK / = �/ 'G�'`'1
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 ..X. NO
SITE ADDRESS(911#/Road Name):
Lr .1 c -
6,j— C- -t- 4 € a__ ZIP 9 f._.?6
9 DIGIT PARCEL ID NUMBER 3//Ye)L. C>
Legal Description: / �,-
Subdivision Name , -G� c .c
sa �c ) l�-f- d ' i Block Lot(s)
Section Township North, Range WM
APPLICANT )(a7 / J� PHONE ?..7 c2 71
MAILING ADDRESS S/ Lei-G4k.- A4.-
ZIP
PROPERTY OWNER )edf9LG' 1 -ii-1.. / > �_ PHONE
MAILING ADDRESS ,-..._, -✓
ZIP g / ��
CONTRACTOR )2(.:4(.1-1 -7,2..-4--- %.i'.�E �3'c< PHONE 3O �O s i ..�7
MAILING ADDRESS 2?lam,c �/��3' t.- iGis� % r/�G w , �}
/ G tj`��y` �/— ^t ZIP 7a?33/
STATE LICENSE# d4/,V0/ /fa 306 EXP.DATE /.... 7 fL
FEDERAL I.D.# 7/ a s LS
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 rig 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 th pplicant's propert 1ructure shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE �----"' DATE .�' / / t°>
FOR OFFICE USE ONLY
BASE FEE $48.00 RECEIPT# C.(216 (
CONSISTENCY REVIEW $24.00 CASH/CK#
_Olt
TOTAL 4 > _.__(�___ ..-_ .� .. ( ..___--1' DATE 3 /1/
Propane Tank applications require additional i 11071 fo be submitted. ��'• ! OVER
Please contact our office at 360-379- 450 if the b in;this application is blank. t' I
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