HomeMy WebLinkAboutBLD2004-00174 •
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 #: BLD04-00174 Received Date 3/19/2004
SITE ADDRESS: 225 ORCHARD VIEW LN Issue Date 3/19/2004
SEQUIM, 98382
APPLICANT: DENNIS W MARTIN PHONE:
105 S 40TH ST
TACOMA WA 984187810
T 63+
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 002342024 Section: 34 Township: 30N Range: 02W
CONTRACTOR: SUBURBAN PROPANE PHONE: 379-5409
P 0 BOX 989
PORT TOWNSEND WA 98368
Contractor's License SUBURPL044DA Expires 3/12/2005
OWNER, DENNIS W MARTIN PHONE:
if different: 105 S 40TH ST
TACOMA WA 984187810
PROJECT DESCRIPTION: PROPANE TANK, PIPING AND HEAT STOVE 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 3/19/2005.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: I(o, ._& ) 01 125)01
['_] FinalApproval — '2 -0 t
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_Propa ne.rpt 10/29/19
4111
BUILDING PERMIT APPLICR' ION BLD04-00174Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD04-00174 Received Date: 3/19/2004
SITE ADDRESS: 225 ORCHARD VIEW LN
SEQUIM, 98382
OWNER: DENNIS W MARTIN PHONE:
105 S 40TH ST
TACOMA WA 984187810
SUBDIVISION: Block: Lot: T 63+
PARCEL NUMBER: 002342024 Section: 34 Township: 30 N Range: 02 W
CONTRACTOR: SUBURBAN PROPANE PHONE: 379-5409
P 0 BOX 989
PORT TOWNSEND WA 98368
Contractor's License SUBURPL044DA Expires 3/12/2005
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION PROPANE TANK, PIPING AND HEAT STOVE 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:
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 PRB 03/19/04 64106
Total: $48.00
` JEFFERSON COUNTY COMM.DEVELOPMENT,621 SHERIDAN ST,PORT TOWOND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* X Above Ground PROPANE TANK* SIZE OF PROPANE TANK COO 0 et
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 la Manufactured/Mobile
Home?
YES K. NO
SITE ADDRESS(911#/Road Name): /
Z z c 0).cn4 t (444,)
/i L2/ram' c- lJ �� ZIP gefJ rf z.
9 DIGIT PARCEL ID NUMBER O7 Z 3 V Z-e) Zi,/
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
(2.s3)
APPLICANT 4.) '%!,/iv/f ' " PHONE V) V 7,ge- 2
MAILING ADDRESS //,5— ,5/
, fd ei.//'i)SA • ZIP gc-'
PROPERTY OWNER 4S/}i-J-t PHONE
MAILING ADDRESS
ZIP
CONTRACTOR SCC 246 i-b PHONE
MAILING ADDRESS
ZIP
STATE LICENSE# i3 GL 1- JD Q yY 019 EXP.DATE -0 2/pop
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 applicant's property or structure shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE L(J W** DATE 3 / /9 / ac�
FOR OFFICE USE ONLY �,��((�� /`' ,�
BASE FEE $48.00 RECEIPT# &lid/ h`f/fib
CONSISTENCY REVIEW $24.00 CASH/CK# 1-n —6
TOTAL 11,00 DATE 3 /1% foLf-
*
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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