HomeMy WebLinkAboutBLD2004-00151 0BUILDING PERMIT APPLICI!ON BLD04-00151
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00151 Received Date: 3/11/2004
SITE ADDRESS: 372 N JACOB MILLER RD
PORT TOWNSEND, 98368
OWNER: CRAIG SCHRADER PHONE:
372 N JACOB MILLER RD
PORT TOWNSEND WA 983689649
SUBDIVISION: TIBBALS LAKE PARK Block: 11 Lot: 1-10
PARCEL NUMBER: 999001101 Section: 5 Township: 30 N Range: 01 W
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 DESCRIPTION NO MLA REQ'D - 250 ABOVE GROUND PROPANE TANK
REPLACEMENT
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:
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 64064
Total: $48.00
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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 #: BLD04-00151 Received Date 3/11/2004
SITE ADDRESS: 372 N JACOB MILLER RD Issue Date 3/11/2004
PORT TOWNSEND, 98368
APPLICANT: CRAIG SCHRADER PHONE:
372 N JACOB MILLER RD
PORT TOWNSEND WA 983689649
1-10
SUBDIVISION: TIBBALS LAKE PARK Block: 11 Lot:
PARCEL NUMBER: 999001101 Section: 5 Township: 30N Range: 01W
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, CRAIG SCHRADER PHONE:
if different: 372 N JACOB MILLER RD
PORT TOWNSEND WA 983689649
PROJECT DESCRIPTION: NO MLA REQ'D -250 ABOVE GROUND 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 03/11/2005.
REQUIRED INSPECTIONS:
[ ] Tank ine/Appliance:
[PKFinalApproval: 774JZ (_*//�
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
JEFFERSON COUNTY COMMU•DEVELOPMENT,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* p Abo e Ground PROPANE TANK* SIZE OF PROPANE TANK 2 50
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 NO
SITE ADDRESS(911#/Road Name):
37Z 4U , la(0 6' /(ems i d
,%i/ T('✓r(-nS(nd / (,-) ZIP -('sS UJ b
9 DIGIT PARCEL ID NUMBER 'qq ,00 1/ 0
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT c�Cf GG/f�GC �-�V K75011 PHONE ,37q
MAILING ADDRESS 372 it) Jacob Ja//ker- Rd
PO7 %O(O/)s-l'1'7 , r.U/' ZIP 9,673bg
PROPERTY OWNER %� SC!7 id de PHONE 7� '��
.MAILING ADDRESS 372 A.) zTh c(6 MI//(Qr PC.d
/, T0uy.c/.id7 L,L)/ ZIP cid 3bJ
CONTRACTOR CP `/JQ S( 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 p perty or structure sh II be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE .S /14u Iy14 DATE / // l l/y
FOR OFFICE USE ONLY ®r '1
BASE FEE $48.00 RECEIPT# [bap
64 c ,'u^1
[ba -
CONSISTENCY REVIEW $24.00 CASH/CK#
TOTAL idAb DATE 3 / 11 / DI-
*
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