HomeMy WebLinkAboutBLD2004-00153 • •
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 #: BLD04-00153 Received Date 3/11/2004
SITE ADDRESS: 846 NESS' CORNER RD Issue Date 3/11/2004
PORT HADLOCK, 98339
APPLICANT: SCOTT L BROWNING PHONE:
LORI A BROWNING
230 RIDGEVIEW DR
PORT TOWNSEND WA 983682512 2
SUBDIVISION: CHARAWELL SHORT PLAT Block: Lot:
PARCEL NUMBER: 901024111 Section: 2 Township: 29N 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, SCOTT L BROWNING PHONE:
if different: LORI A BROWNING
230 RIDGEVIEW DR
PORT TOWNSEND WA 983682512
PROJECT DESCRIPTION: NO MLA REQ'D -ABOVE GROUND 250 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 03/11/2005.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[ ] FinalApproval:MA -7/-At
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
is\F_BLD_Permit_Propane.rpt 10/29/19c
3UILDING PERMIT APPLICAION BLD04 001153
w Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00153 Received Date: 3/11/2004
SITE ADDRESS: 846 NESS' CORNER RD
PORT HADLOCK, 98339
OWNER: SCOTT L BROWNING PHONE:
LORI A BROWNING
230 RIDGEVIEW DR
PORT TOWNSEND WA 983682512
SUBDIVISION: CHARAWELL SHORT PLAT Block: Lot: 2
PARCEL NUMBER: 901024111 Section: 2 Township: 29 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 DESCRIPTIOP NO MLA REQ'D -ABOVE GROUND 250 GALLON PROPANE TANK
REPLACEMENT
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION
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: 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 64068
Total: $48.00
JEFFERSON COUNTY COMMUNDEVELOPMENT,621 SHERIDAN ST,PORT TOW D WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION -su>>4P p--
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* Above Ground PROPANE TANK* SIZE OF PROPANE TANK 2 Se)
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):
Pt . A 0(0Cf ZIP 11,111
9 DIGIT PARCEL ID NUMBER etiO l— C`- '— 1 ) 1
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT \ c-tL NOS? k IAA. , (� PHONE
MAILING ADDRESS 4lS 7 lam } n-- (LA
(1 ilftt, L, ZIP
PROPERTY OWNER -At .4),,, Y I tO6 PHONE
MAILING ADDRESS
ZIP
n
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 applican,', property or structure,shall be requested
daand
�shall occur during regular business hours.
)W41-?
APPLICANTS SIGNATURE 1014 (dL ''`�r . . l` DATE '3 /1 ( / 6 cf
OR OFFICE USE ONLY COI
BASE FEE $48.00 RECEIPT# C d 0(LA<
CONSISTENCY REVIEW $24.00 CASH/CK# CAstt
TOTAL DATE 3 / I( / v
*
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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