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HomeMy WebLinkAboutBLD2004-00196 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 #: BLD04-00196 Received Date 3/29/2004 SITE ADDRESS: 1251 THORNDYKE RD Issue Date 3/29/2004 PORT LUDLOW, 98365 APPLICANT: JOHN EMRICK PHONE: 360-509-6322 ALDEEN M EMRICK 1251 THORNDYKE RD PORT LUDLOW WA 98365 SUBDIVISION: TRAILS END HOMESITES 43 Block: 3 Lot: PARCEL NUMBER: 950100341 Section: 16 Township: 27N Ranqe: 01 E CONTRACTOR: C H S PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**979OZ Expires 09/06/2004 OWNER, JOHN EMRICK PHONE: 360-509-6322 if different: ALDEEN M EMRICK 1251 THORNDYKE RD PORT LUDLOW WA 98365 PROJECT DESCRIPTION: 120 GAL PROPANE TANK AND GAS LINE 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 03/29/2005. REQUIRED INSPECTIONS: [ ] Tank/Line/Appliance: IAA.- b lr;• [ FinalApproval: ( LiI Zoo-1-1 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 I UILDING PERMIT APPLICA JN BLD03-00672 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD04-00196 Received Date: 3/29/2004 SITE ADDRESS: 1251 THORNDYKE RD PORT LUDLOW, 98365 OWNER: JOHN EMRICK PHONE 360-509-6322 ALDEEN M EMRICK 1251 THORNDYKE RD PORT LUDLOW WA 98365 SUBDIVISION: TRAILS END HOMESITES Block: 3 Lot: 43 PARCEL NUMBER: 950100341 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 DESCRIPTION PROPANE TANK AND GAS LINE 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: GARAGE: SHORELINE: CONST TYPE: 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 3/�9 0�/ Shoreline Aquifer /r Forest: Commercial _ Rural Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $48.00 ZAN 03/29/04 64202 Total: $48.00 JEFFERSON COUNTY COMMUNI•EVELOPMENT,621 SHERIDAN ST.PORT TOWNS '� WA 98368 PH: (360)379-4450 INSTALLATION PERMIT APPLICATION MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION r Underground PROPANE TANK* r Above Ground PROPANE TANK* SIZE OF PROPANE TANK /:.:?(, Pa 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): 4,C1( c,r, ZIP 9 DIGIT PARCEL ID NUMBER r°� 1 /C7O _„� y� Legal Description: Subdivision Name /rii (5 Block Lot(s) Section Township North, Range WM APPLICANT if /ryy L G/( PHONE (14;/ 574.7 0 MAILING ADDRESS j,) S l (� r�.2,re, 'h r� C - ;- I' L�. / 4.. Fr 6 S ., ZIP PROPERTY OWNER 6.44 PHONE MAILING ADDRESS ZIP CONTRACTOR -6.y( PHONE MAILING ADDRESS 0,1,t A ,,," e tom. L-)Cc.., 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 Counter niY: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 s _c/ure shal a requested and shall occur during regular business hours. APPLICANTS SIGNATURE ✓✓' DATE] / FOR OFFICE USE ONLY BASE FEE $48.00 RECEIPT# tLJ cf abc)- CONSISTENCY REVIEW $24.000 CASH/CK# q I / C7 TOTAL DATE 3 .?/ Propane Tank applications require additional information to be submitted. Please contact our office at 360-379-4450 if the back of this application is blank. 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