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Home My WebLink AboutBLD2004-00226 BUILDING PERMIT APPLICIION B RD04-0eview 0p226 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD04-00226 Received Date: 4/6/2004 SITE ADDRESS: 123 VANCOUVER LN PORT TOWNSEND, 98368 OWNER: PAUL D ROGLAND PHONE: 123 VANCOUVER LN PORT TOWNSEND WA 983689675 SUBDIVISION: DISCOVERY BAY HEIGHTS DIV 1 Block: Lot: 11 PARCEL NUMBER: 947300011 Section: 32 Township: 30 N Range: 01 W CONTRACTOR: C H S PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/6/2004 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOt PROPANE TANK INSTALLATION TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 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 PRB 04/06/04 64128 Total: $48.00 • 0 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 #: BLD04-00226 Receivec Date 4/6/2004 SITE ADDRESS: 123 VANCOUVER LN Issue Date 4/6/2004 PORT TOWNSEND, 98368 APPLICANT: PAUL D ROGLAND PHONE: 123 VANCOUVER LN PORT TOWNSEND WA 983689675 11 SUBDIVISION: DISCOVERY BAY HEIGHTS DIV 1 Block: Lot: PARCEL NUMBER: 947300011 Section: 32 Township: 30N Range: 01W CONTRACTOR: C H S PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/6/2004 OWNER, PAUL D ROGLAND PHONE: if different: 123 VANCOUVER LN PORT TOWNSEND WA 983689675 PROJECT DESCRIPTION: PROPANE TANK INSTALLATION 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 4/6/2005. REQUIRED INSPECTIONS: [ ] Tank/Line/Appliance: [ 1 FinalApproval: ///;3P://4? 7-11W C ON1 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 w t-+ ►.• 1 JEFFERSON COUNTY COMM.DEVELOPMENT,621 SHERIDAN ST,PORT TOWND WA,b4368 PH: B-)-3-7 INSTALLATION PERMIT APPLICATION ---/ S wiTG , c 9 - MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION Underground PROPANE TANK* Above Ground PROPANE TANK* SIZE OF PROPANE TANK)c' �� 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): 7-1 UaN Cot(u-CO-- LANL- R :Tay VI ZIP 4V5365 9 DIGIT PARCEL ID NUMBER q i-r7" S 00— O f! / Legal Description: Subdivision Name Block Lot(s) /� Section Township North, Range WM APPLICANT 1�OW )40 / (/Q l Lt L PHONE "�j —05 9 6. MAILING ADDRESS 12-3 V,1+V rc vie-- ( 4 1' ( I- ZIP PROPERTY OWNER PHONE MAILING ADDRESS / J/ ZIP CONTRACTOR 1,,,, j'{ ' ` 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 to the appli is propert r ucture shall be requested and shall occur during regular business hours. ,L/ APPLICANTS6 SIGNATURE l.. efi_,1 iC+ V DATE l L< lo, (J FOR OFFICE USE ONLY /( BASE FEE $48.00 RECEIPT# 6O4-12—Z CONSISTENCY REVIEW �—t 4r � 4 24.00 CASH/CK# "S ^ TOTAL 72.00 DATE - / C, / o 4— 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. APR — 62004 G:\PermitCenter\FORMS\BLDG FORMS\install-revised 01-26-04.DOC • RAN0 , PA'A Li Ega_ • 3 -7c-) _ 6sy-c `7(17- 30o- oil 123 VANi o_ouv-e( L/ -1\f,c, — zso 616LuDN ABov ou N O sw�Tc-t-t ouT- i •P fie.. 1 \0 36% 4 . - z F(6 0° .7 -i ', / Y f� � �� / • �✓j2 / � APR fi