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Home My WebLink AboutBLD2004-00205 • •UILDING PERMIT APP AION BLD04-002205 view Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD04-00205 Received Date: 3/31/2004 SITE ADDRESS: 180 PLUTE RD NORDLAND, 98358 OWNER: LAKSHMINARAYANAN S PHONE: 1608 E GARFIELD ST SEATTLE WA 981122820 SUBDIVISION: Block: Lot: PARCEL NUMBER: 021282018 Section: 28 Township: 30 N Range: 01 E CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTPI98306 Expires 09/26/2004 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr NO MLA REQ'D -AG 250 GALLON PROPANE TANK, HEAT STOVE, COOKING STOVE 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 Bv: Date: Receipt: Approved/Date Propane Tanks/Stoves $48.00 CJZ 03/31/04 64252 Total: $48.00 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 $72.00. w t 3 ref). polo //F14,2P'e G:\PermitCenter\FORMS\BLDG FORMS\install-revised 01-26-04.DOC • • . • • • PROPANE/PELLET/VVOOD STOVE & TANK INSTALLATION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD04-00205 Received Date 3/31/2004 SITE ADDRESS: 180 PLUTE RD Issue Date 3/31/2004 NORDLAND, 98358 APPLICANT: LAKSHMINARAYANAN S PHONE: 1608 E GARFIELD ST SEATTLE WA 981122820 SUBDIVISION: Block: Lot PARCEL NUMBER: 021282018 Section: 28 Township: 30N Range: 01 E CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTP198306 Expires 09/26/2004 OWNER, LAKSHMINARAYANAN S PHONE: if different: 1608 E GARFIELD ST SEATTLE WA 981122820 PROJECT DESCRIPTION: NO MLA REQ'D -AG 250 GALLON PROPANE TANK, HEAT STOVE, COOKING STOVE THIS PERMIT IS VALID FOR ONE YEAR AND IS NOT RENEWABLE. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 03/31/2005. REQUIRED INSPECTIONS: [ ] Tank/Line/Appliance: FinalApproval: ICE>i:1 p �511 d BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS. Office Hours 9:00 a.m. -4:30 p.m. HOT LINE AVAILABLE 24 HOURS A DAY 1:1F_BLD_Permit_Propane.rpt 10/29/19. N JEFFERSON COUNTY CUN.EVELOPMENT,621 SHERIDAN ST,POROWNOD WA 98368 PH: (360)379-4450 INSTALLATION PERMIT APPLICATION MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION Underground PROPANE TANK* VAbove Ground PROPANE TANK* SIZE OF PROPANE TANK 2-5-6) ✓HEAT STOVE HOT WATER TANK WOODSTOVE FIREPLACE INSERT PELLET STOVE ✓COOKING STOVE OTHER(Please Specify) Is this appliance(woodstove, htg stove, hot water tank,furnace,etc.)to be installed in a Manufact .1; obile Q Home? `- -.w- YES ✓NO = - SITE ADDRESS(911#/Road Name): 1130 pi,,,- re /20/0 V i ,. . Z C) /Vordlgwo/ ZIP 983Sg En cc 9 DIGIT PARCEL ID NUMBER 0.2-1 a$a- O/ LL- Legal Description: --s Subdivision Name Block Lot(s) Section Township North, Range WM APPLICANT Mountain Propane PHONE 3 35 .- 6 SS. 2 5 Chimacum Rd. MAILING ADDRESS Port Hadicck,WA 98339 v ZIP A PROPERTY OWNER Mr. ).4 s),{y,7 , / PHONE �O-3,3-9 - �Z-7O MAILING ADDRESS ADS �i 6-C7rP,L?/u/ $,oq/Jto, Wg, ZIP g S//..1— CONTRACTOR I!"ou!n$ain Propane PHONE ,3$S" - 6 s.s 3 s5 Chimacum Rd. MAILING ADDRESS Port liadlock,WA 38333 ZIP STATE LICENSE# MOi,0P-L 4$3O6 EXP.DATE 7- 0Lt —C y FEDERAL I.D.# II) a06-86SS- 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 diT g ✓�- DATE / / FOR OFFICE USE ONLY y BASE FEE $48.00 RECEIPT# 6 J c CONSISTENCY REVIEW $24.00 CASH/CK# �(. TOTAL DATE / `r` i Cj' \ 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