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Home My WebLink AboutBLD2004-00161 • S 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 #: BLD04-00161 Received Date 3/16/2004 SITE ADDRESS: 143 DOGLEG LN Issue Date 3/16/2004 PORT LUDLOW, 98365 APPLICANT: DONALD N MERRIKIN PHONE: RENA L MERRIKIN 115 CLEAR VIEW PL PORT LUDLOW WA 983658000 12 SUBDIVISION: FAIRWOOD VILLAGE Block: Lot: PARCEL NUMBER: 951400012 Section: 21 Township: 28N Range: 01 E CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2004 OWNER, DONALD N MERRIKIN PHONE: if different: RENA L MERRIKIN 115 CLEAR VIEW PL PORT LUDLOW WA 983658000 PROJECT DESCRIPTION: NO MLA REQ'D -AG 120 GALLON PROPANE TANK& FIREPLACE INSERT 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 03/16/2005. REQUIRED INSPECTIONS: [ ] Tank/Line/Appliance: VW L O.k 1'//1/6 4 MOri4 Lww OK 4/4.701- ips&zr (t.)11-41-1-A-noo f/o/(04 64/ [ ] FinalApproval: 40K _.?a, fi I 1 4 iJJ 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 10/29/19c ilt UILDING PERMIT APPLICASDN BLD04-00161 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD04-00161 Received Date: 3/16/2004 SITE ADDRESS: 143 DOGLEG LN PORT LUDLOW, 98365 OWNER: DONALD N MERRIKIN PHONE: RENA L MERRIKIN 115 CLEAR VIEW PL PORT LUDLOW WA 983658000 SUBDIVISION: FAIRWOOD VILLAGE Block: Lot: 12 PARCEL NUMBER: 951400012 Section: 21 Township: 28 N Range: 01 E CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2004 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION NO MLA REQ'D -AG 120 GALLON PROPANE TANK & FIREPLACE INSERT 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 03/16/04 64076 Total: $48.00 JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNSEND WA 98368 PH: (360)379-4450 INSTALLATION PERMIT APPLICATION MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION Underground PROPANE TANK* Above Ground PROPANE TANK* �SIZE OF PROPANE TANK � 0 644.L HEAT STOVE HOT WATER TANK WOODSTOVE f!/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 p/NO SITE ADDRESS(911 #/Road Name): /4/3 2c&LEG- L441A)E pp2T LuiL w ZIP a1�3(pJ 9 DIGIT PARCEL ID NUMBER 957 400 0/ Legal Description: Subdivision Name Block —Lot(s) Section �A Township North, Range WM APPLICANT c�>('Y� L j� 4/ C`Z2/Y) PHONE MAILING ADDRESS /93 /0dr PORT L.1/6L-Dk_) ZIP [ , /p� PROPERTY OWNER "� PHONE 4 3 7- 6/'/4/ MAILING ADDRESS ZIP CONTRACTOR PHONE MAILING ADDRESS �% L( 4C cu 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 t applicant's property or structure shall be requested and shall occur during regular business hours. • APPLICANTS SIGNATURE _.�iif D/1 /E, DATE FOR OFFICE USE ONLY BASE FEE $48.00 RECEIPT# CONSISTENCY REVIEW $24.00 CASH/CK# TOTAL DATE / / 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 Propane Tank Application Requirements 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. 5 C r42r4G ce- G:\PermitCenter\FORMS\BLDG FORMS\install-revised 01-26-04.DOC