HomeMy WebLinkAboutBLD2004-00225 libBLD99-00454
UILDING PERMIT APPLICAN Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD04-00225 Received Date: 4/5/2004
SITE ADDRESS: 5825 OLD GARDINER RD
PORT TOWNSEND, 98368
OWNER: MARK A GETZENDANER III PHONE: (360)379-8125
5825 OLD GARDINER RD
PORT TOWNSEND WA 98368
SUBDIVISION: OLSEN SHORT PLAT Block: Lot: 1
PARCEL NUMBER: 902133007 Section: 13 Township: 29 N Range: 02 W
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 PROPANE HEAT STOVE AND GAS PIPING
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: L� F&W Landslide
/ / Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid Bv: Date: Receipt: Approved/Date
Total:
A I V
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 #: BLD04-00225 Received Date 4/5/2004
SITE ADDRESS: 5825 OLD GARDINER RD Issue Date 4/6/2004
PORT TOWNSEND, 98368
APPLICANT: MARK A GETZENDANER III PHONE: (360)379-8125
5825 OLD GARDINER RD
PORT TOWNSEND WA 98368
1
SUBDIVISION: OLSEN SHORT PLAT Block: Lot:
PARCEL NUMBER: 902133007 Section: 13 Township: 29N Range: 02W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2004
OWNER,
if different:
PROJECT DESCRIPTION: PROPANE 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: S J 4/21/c (
rf
[ ] FinalApprova a—5-0
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
JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNSEND WA 98368 PH: (360)379-4450
I1ALLATION PERMIT APPLICATIO.
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
A..—.,
T
UndergroundrgasO E TANK* Above Ground PROPANE TANK* SIZE OF PROPANE TANK 4i1irJ ���
HEAT STOVE HOT WA
TER TANK WOODSTOVE FIREPLACE INSERT PELLET STOVE
COOKING STOVE (Please Specify) r
Is this appliance(woodstove, htg stove, hot water to ,furnace, etc.)to be installed in a Manufactured/Mobile
Home?
YES NO
SITE ADDRESS(911#/Road Name): �Q �,p
yas 0t"C -//,-vines ie-141
pi 1 0 ,3 I'1 JQ ZIP dJ 6d7
9 DIGIT PARCEL ID NUMBER 9 Q /3 3 O O 7
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT /L GC 7 -e ri d ¢,-- PHONE 3 7 7 d/ 2_1--
MAILING ADDRESS Cil" ——.
ZIP
PROPERTY OWNER /-a/L�C— �f PHONE
MAILING ADDRESS 7
// ZIP p
CONTRACTOR4 f l+.��s-_.�_ ojtiry,aY//•��.�,_ PHONE 3 G S 7 7
MAILING ADDRESS / 0 7j�.j ,eA_ .0r
Pr c / ( `� ` ZIP '��_3y
STATE LICENSE# ,56G/?J elf,c 77 GIP EXP.DATE /2.-0 y
FEDERAL I.D.# c / /O 7 qC "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 Jeffer n 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 t e applicant's pr perty or structure shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE £1"0- DATE V./ / / O
FOR OFFICE USE ONLY be/do '?
��
BASE FEE $48.00 RECEIPT#
CONSISTENCY REVIEW CASH/CK# 953 /
TOTAL 6`C�i t0 DATE 1// (Q /.y
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. OVER
G:\PermitCenter\FORMS\BLDG FORMS\install-revised 01-26-04.DOC
SITE VISIT REPORT
(PLOT PLAN)
JOB / r4 6°/ eiir DATE : 3A//7GI
ADDRESS JOB PHONE #:
FAX #:
Email
PLANNER: r[ -:
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