HomeMy WebLinkAboutBLD2004-00164 •
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 #: BLD04-00164 Receoved Date 3/17/2004
SITE ADDRESS: 215 N BEACH DR Issue Date 3/17/2004
PORT LUDLOW, 98365
APPLICANT: JOSEPH C SCHWAN PHONE:
JACQUELIN L SCHWAN
215 N BEACH DR
PORT LUDLOW WA 983659270 22
SUBDIVISION: BRIDGEHAVEN DIV 7 Block: Lot:
PARCEL NUMBER: 935700021 Section: 16 Township: 27N Range: 01E
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, JOSEPH C SCHWAN PHONE:
if different: JACQUELIN L SCHWAN
215 N BEACH DR
PORT LUDLOW WA 983659270
PROJECT DESCRIPTION: NO MLA REQ'D -AG 120 GALLON PROPANE & 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 03/17/2005.
REQUIRED INSPECTIONS:
14 Tank/Line/Appliance: K DK 3 ®N7-ER,6e 44<110E Oki 6RE-Pi et /iuS r.er dK 0-1Aff,
N>oci. FinalApproval: l3K .c'�r- e/6 33q,
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 APPLICA•N BLD04 001164
w Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00164 Received Date: 3/17/2004
SITE ADDRESS: 215 N BEACH DR
PORT LUDLOW, 98365
OWNER: JOSEPH C SCHWAN PHONE:
JACQUELIN L SCHWAN
215 N BEACH DR
PORT LUDLOW WA 983659270
SUBDIVISION: BRIDGEHAVEN DIV 7 Block: Lot: 22
PARCEL NUMBER: 935700021 Section: 16 Township: 27 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 DESCRIPTIOP NO MLA REQ'D -AG 120 GALLON PROPANE & 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:
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 03/17/04 64079
Total: $48.00
tekix.. JEFFERSON COUNTY COMMU EVELOPMENT,621 SHERIDAN ST,PORT TOWN 9 8 ri: IaOf37 45g �'
INSTALLATION PERMIT APPLICATION ry r
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION 1 ` s l I a
L MAR 1 7 2004
Underground PROPANE TANK* - bove Ground PROPANE TANK* SIZE OF PROPANE TANK
EAT STOVE HOT WATER TANK WOODSTOVE FIREPLACE INSERT pp r7 OVE '
v�PT. UF�.a r', .ST ��.OprY,'_ .I
COOKING STOVE OTHER(Please Specify) _ r
Is this appliance(woodstove, htg stove, hot water tank,furnace, etc.)to be installed in a Manufactured/Mobile
Home? /
YES V NO
SITE ADDRESS(911#/Road Name):
Aq N riiN ROCX,Qifl Irc-I tir(2_,. D
to «} • ZIP his 3(u S
9 DIGIT PARCEL ID NUMBER *1 j- S 1 0c 0 2.. 1
Legal Description:
Subdivision Name let-' dine" k ,,.'1 Block Lot(s) 6/2
Section Township North, Range WM
APPLICANT )0 i A �e4A,(A)C�r'\ PHONE 3 -1 a, l
MAILING ADDRESS a, IS No 1-Th a Q C.u'-'" C)
PC r t bOck.. ZIP Oi 9 (a
PROPERTY OWNER ; QQ J- ( svoVo j S PHONE 3(0O•-- t-t ) 1 Cj L-(, I
MAILING ADDRESS a L S N O/- tic\ t( J1tl,-\ C
L4..I Ot..) 1, ,� ZIP a S 3(o c
CONTRACTOR I� }'Q,x f� PHONE 3 Co 0— 7 3 2---1j Sj S3
MAILING ADDRESS ]P o B Oy 2.4 9j
f_A.4°Y\ j t1 & ZIP et <J,-A.
STATE LICENSE# t --Li
t 6r7 d1 O Z EXP.DATE �'1 I (p /;4,00t"I
FEDERAL I.D.# 6 ] — (�rZ rJ ®q 5I
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 �� I2,(11 ( wvCtiy\ DATE / / (T)--r
FOR OFFICE USE ONLY
BASE FEE $48.00 RECEIPT#
CONSISTENCY REVIEW $24.00 CASH/CK# .4860
TOTAL DATE 3 / /7 / 01-
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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