HomeMy WebLinkAboutBLD2004-00145 • 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 #: BLD04-00145 Received Date 3/11/2004
SITE ADDRESS: 81 PUGET LOOP Issue Date 3/11/2004
PORT LUDLOW, 98365
APPLICANT: KENNETH R WINTER TRUSTEE PHONE:
DOROTHY M WINTER TRUSTEE
81 PUGET LOOP
PORT LUDLOW WA 983659707 62
SUBDIVISION: PORT LUDLOW NO 1 AREA 1 Block: Lot:
PARCEL NUMBER: 990400162 Section: 9 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 09/06/2004
OWNER, KENNETH R WINTER TRUSTEE PHONE:
if different: DOROTHY M WINTER TRUSTEE
81 PUGET LOOP
PORT LUDLOW WA 983659707
PROJECT DESCRIPTION: NO MLA REQ'D -ABOVE GROUND 120 GALLON PROPANE
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 03/11/2005.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: �jU u /As 5Tmi1 ial) IJNL,y r k
[ ] FinalApproval: r%A -ter G ' 2 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£
UILDING PERMIT APPLIC•ON BLD04-00145
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00145 Received Date: 3/11/2004
SITE ADDRESS: 81 PUGET LOOP
PORT LUDLOW, 98365
OWNER: KENNETH R WINTER TRUSTEE PHONE:
DOROTHY M WINTER TRUSTEE
81 PUGET LOOP
PORT LUDLOW WA 983659707
SUBDIVISION: PORT LUDLOW NO 1 AREA 1 Block: Lot: 62
PARCEL NUMBER: 990400162 Section: 9 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 09/06/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI NO MLA REQ'D -ABOVE GROUND 120 GALLON PROPANE
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 03/11/04 62687
Total: $48.00
JEFFERSON COUNTY COMMUI. EVELOPMENT,621 SHERIDAN ST,PORT TOWN WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
2 ¢Inderground PROPANE TANK* x Above Ground PROPANE TANK* SIZE OF PROPANE TANK / V e a,[
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 TNO)
SITE ADDRESS(911#/Road Name):
P 1 — p � L �, Ja ,,,"? ;, t +�
p ZIP i' 3 �, .�-
9 DIGIT PARCEL ID NUMBER 9(1I0 � /o tO 2-
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT L -'*- a.- PHONE 1t 3 7- 2..`?f T -]
MAILING ADDRESS '6I- 1�✓ �� Lt., 0 (J
o' ZIP
PROPERTY OWNER PHONE
MAILING ADDRESS
ZIP MAR 1 0 2004
CONTRACTOR C 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 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 property or structure shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE JC �r DATE 3 / ry l 2-4
FOR OFFICE USE ONLY �Z���
BASE FEE $48.00 RECEIPT#
CONSISTENCY REVIEW $24.00 CASH/CK# 2"-1
TOTAL 72-•oD DATE /1 0 / - 1
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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