HomeMy WebLinkAboutBLD2004-00224 •
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 #: BLD04-00224 Received Date 4/5/2004
SITE ADDRESS: 2 PHINNEY LN Issue Date
PORT LUDLOW, 98365 4/6/2004
APPLICANT: JANET F STARK
2 PHINNEY LN PHONE:
PORT LUDLOW WA 983659774
SUBDIVISION: PORT LUDLOW#1 Block:
Lot:
PARCEL NUMBER: 990400172 Section: 16 Township: 28N Range: 01 E
CONTRACTOR: SUNSHINE PROPANE
10853 RHODY DR PHONE: 385-5797
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2004
OWNER, JANET F STARK
if different: 2 PHINNEY LN PHONE:
PORT LUDLOW WA 983659774
PROJECT DESCRIPTION: GAS HEAT STOVE AND GAS PIPING
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 04/06/2005.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: 'AK gxignoc J rc,,eoz_ ZwE 1k10/G4/ IRA-E .S?.9auDh.+t
J/F, _ 6k 4/?/a, j
[ ] FinalApproval: dk' -r e/Q iti/7 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
I:\F_BLD_Permit_Propane.rpt
10/29/19
4ICUILDING PERMIT APPLICA41/0N BLD03-00789
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00224 Received Date: 4/5/2004
SITE ADDRESS: 2 PHINNEY LN
PORT LUDLOW, 98365
OWNER: JANET F STARK PHONE:
2 PHINNEY LN
PORT LUDLOW WA 983659774
SUBDIVISION: PORT LUDLOW#1 Block: Lot:
PARCEL NUMBER: 990400172 Section: 16 Township: 28 N Range: 01 E
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION GAS HEAT STOVE AND GAS PIPING
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:
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
(0
Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Total:
JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNSEND WA 98368 PH: (360)379-4450
,.
IALLATION PERMIT APPLICATIOjo
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION � ,
Underground PROPANE TANK* Above Ground PROPANE TANK* SIZE OF PROPANE TANK -j�r O T- i ` ' .J'
-
s-i 1S Iti�L / -Al
2(H T STOVE HOT WATER TANK vvuuus l-OVE FIREPLACE INSERT PELLET STOVE
COOKING STOVE ,, OTHER(Please Specify) p vim_
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):
44- 'J--- Pii., jc_.1 Z...:ki
/ r - LL LQ L. W'ZIP 9 U 3 6 1-----
r
9 DIGIT PARCEL ID NUMBER q9 v 1100 /7 Z----
Legal Description:
Subdivision Name Block Lot(s)
Section nn Township North, Range WM
AAPPLICANT !X S tdrir-P--4-7- / �j C� )
1 ���'� PHONE iz) 7 a ! ( o
MAILING ADDRESS
ZIP
PROPERTY OWNER C 4-1-7` PHONE
MAILING ADDRESS
ZIP CONTRACTOR .51 Pjt.rr 4"+---4- tJJ_ PHONE 3 ^ S 7/C
2
MAILING ADDRESS /Des--J /Q r y
P1 1\ c..k_ L.)c_ ZIP ! LJ)� 7/
STATE LICENSE# cJ e/ S-j j/7CP r 7 7 Q p EXP.DATE ///U y
FEDERAL I.D.# '/- (/0 7 7 O J 7
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 Cou 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 ap icant's property or tructure shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE _ DATE / ( / 0 Y
FOR OFFICE USE ONLY
BASE FEE $48.00 RECEIPT#
CONSISTENCY REVIEW $24.00 CASH/CK#
•
TOTAL DATE / /
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
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