HomeMy WebLinkAboutBLD2004-00193 •
BLD04-00193
BUILDING PERMIT APPLICAt()N Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00193 Received Date: 3/25/2004
SITE ADDRESS: 470 TALA SHORE DR
PORT LUDLOW, 98365
OWNER: CLIFFORD M ELBERT TRUSTEE PHONE:
JO ANNE ELBERT TRUSTEE
470 TALA SHORE DR
PORT LUDLOW WA 983659262
SUBDIVISION: TALA SHORES#3 Block: 3 Lot: 13
PARCEL NUMBER: 998200313 Section: 15 Township: 28 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 - 250 AG PROPANE TANK
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: 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 03/25/04 64098
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#: BLD04-00193 Received Date 3/25/2004
SITE ADDRESS: 470 TALA SHORE DR Issue Date 3/25/2004
PORT LUDLOW, 98365
APPLICANT: CLIFFORD M ELBERT TRUSTEE PHONE:
JO ANNE ELBERT TRUSTEE
470 TALA SHORE DR
PORT LUDLOW WA 983659262 13
SUBDIVISION: TALA SHORES#3 Block: 3 Lot:
PARCEL NUMBER: 998200313 Section: 15 Township: 28N 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, CLIFFORD M ELBERT TRUSTEE PHONE:
if different: JO ANNE ELBERT TRUSTEE
470 TALA SHORE DR
PORT LUDLOW WA 983659262
PROJECT DESCRIPTION: NO MLA REQ'D -250 AG PROPANE TANK
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 03/25/2005.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: FFZaP,4W- -1740 k DK 12/2-7 0 1
[ ] FinalApproval: (7,k tar Ina,! I2/Z/ai A/
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£
JEFFERSON COUNTY COMMUNI VELOPMENT 621 SHERIDAN ST PORT TOWN •98368PH: 360 379-445
INSTALLATION PERMIT APPLICATION -----5 /P 4u
7-
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
A
Underground PROPANE TANK* Above Ground PROPANE TANK* SIZE OF PROPANE TANK
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 i nufactured/Mobile 1 1
Home? '
YES NO MAR 2 5 2004 I
SITE ADDRESS(911#//Road Name): y
—1 1 L. A -�C)c 4 V'ed cPT. OF C_a'° x_i tv; .1
1C)\,Q V� ZIP ��J Cj j
9 DIGIT PARCEL ID NUMBER .95%tg` zoo- 313
Legal Description:
Subdivision Name Block Lot(s)
Section / Township North, Range WM
APPLICANT �-C � PHONE
MAILING ADDRESS 474 ! r l k � � .
• IOVJ ZIP
PROPERTY OWNER PHONE
MAILING ADDRESS
ZIP
CONTRACTOR _ 1 3 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_lp_t4ie.ep li t's- ro ert tructure all be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE 1. I �4fS DATE /t�S /d
FOR OFFICE USE ONLY �Q F
BASE FEE $48.00 RECEIPT#CONSISTENCY REVIEW $24.00 CASH/CK# C ! C t
TOTAL GIC DATE 3 a b/d1
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