HomeMy WebLinkAboutBLD2004-00146 • •
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 #: BLD04-00146 Received Date 3/11/2004
SITE ADDRESS: 6062 HIGHWAY 20 Issue Date 3/11/2004
PORT TOWNSEND, 98368
APPLICANT: MADELEINE SAENZ PHONE:
6062 STATE ROUTE 20#56
PORT TOWNSEND WA 983689301
SUBDIVISION: OLYMPIC MOBILE VILLAGE IMPS ON Block: Lot:
PARCEL NUMBER: 978706056 Section: 33 Township: 30N Range: 01W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPI98306 Expires 9/26/2004
OWNER, MADELEINE SAENZ PHONE:
if different: 6062 STATE ROUTE 20#56
PORT TOWNSEND WA 983689301
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 3/11/2005.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[ FinalApproval: 7—"7J/ < Y//7/ y
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
•
BUILDING PERMIT APPLI TION BLD04-00146Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00146 Received Date: 3/11/2004
SITE ADDRESS: 6062 HIGHWAY 20
PORT TOWNSEND, 98368
OWNER: MADELEINE SAENZ PHONE:
6062 STATE ROUTE 20#56
PORT TOWNSEND WA 983689301
SUBDIVISION: OLYMPIC MOBILE VILLAGE IMPS ON Block: Lot:
PARCEL NUMBER: 978706056 Section: 33 Township: 30 N Range: 01 W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPI98306 Expires 9/26/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr PROPANE TANK INSTALLATION
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:
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: . Z I t / C ',_ F&W Landslide
Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 PRB 03/10/04 62689
Total: $48.00
JEFFERSON COUNTY COMMUNI•EVELOPMENT,621 SHERIDAN ST,PORT TOWN*WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TOTHIS INSTALLATION
nderground PROPANE TANK* IV Above Ground PROPANE TANK* SIZE OF PROPANE TANK i, V
bA4 t AT 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?
i` YES NO
SITE ADDRESS(911#/Road Name):
0 6 ' P O an p e. Uivaa,.P�
1 o1-"-- W V PA1 a ,✓w� A- ZIP 4 81-1 6
-Y 9 DIGIT PARCEL ID NUMBER 7 8 ` o�! V 5 gj
Legal Description: MAR 0 2004
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT �I�Q d CJe II e. 5 Z PHONE
MAILING ADDRESS c,D6 to S+c1) e 19-O(...lit e o ,O p (
S (p'S l]�� te, V ll( c
cA)0r l dwn-&d WA- ZIP �"L tA
PROPERTY OWNER 5a.. Mk, Q. ak t`,,if e, PHONE
MAILING ADDRESS
ZIP
t
CONTRACTOR ).—OLLL.S YI. PHONE
qMAILING ADDRESS OU iu n `J pah--e_. / D.it [4 GIA lo c) WA
o \0(1.)hge/nd U I zip qm6 O
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 ap n's prope or s ructLre shall be requ ted and shall occur during regular business hours.
APPLICANTS SIGNATURE ( (C. i f Q C1Q4t 2- DATE 0 3 / )0 / O4-
FOR OFFICE USE ONLY BASE FEE $48.00 RECEIPT# (o.C//',n
CONSISTENCY REVIEW $24.00 CASH/CK# ' (4-53
TOTAL 7 Z-oO DATE 3, .D , 04--
*
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 Proplie Tank Application Regiments
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