HomeMy WebLinkAboutBLD2004-00242 BLD00-00318
IICUILDING PERMIT APPLIC•ON Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00242 Received Date: 4/14/2004
SITE ADDRESS: 3546 THORNDYKE RD
PORT LUDLOW, 98365
OWNER: RICHARD WELTER PHONE: (360)297-2365
21238 JEFFERSON BCH RD
KINGSTON WA 98346
SUBDIVISION: Block: Lot: 2
PARCEL NUMBER: 721194003 Section: 19 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 DESCRIPTIOP 500 GAL. ABOVE GROUND PROPANE TANK
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: �/ F&W Landslide
7 /� 11V / Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: / pproved/Date
Propane Tanks/Stoves $48.00 ZAN 04/14/04 64218
Total: $48.00
JEFFERSON COUNTY COMMUNDEVELOPMENT,621 SHERIDAN ST,PORT TOWD WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION j' Q cJ1/4-1'
Underground PROPANE TANK* Above Ground PROPANE TANK* SIZE OF PROPANE TANK
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):
Wt-o la9 �y ZIP 9 F -
9 DIGIT PARCEL ID NUMBER 12- ` -/`60 j
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range / WM
� — �APPLICANT - - �-� PHONE S 7�l 2
MAILING ADDRESS 510. a"
ZIP
PROPERTY OWNER PHONE
MAILING ADDRESS
/ ZIP
CONTRACTOR (-+ PHONE
MAILING ADDRESS `L
aPRh
ZIP`
STATE LICENSE# EXP.DATE Jt" •) .
FEDERAL I.D.# ? t�s t--1 -=� '
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 applican' property or structure shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE f ai6
DATE / / �(d>
FOR OFFICE USE ONLY
BASE FEE $48.00 RECEIPT#
CONSISTENCY REVIEW $24.00 CASH/CK# eAs
TOTAL DATE '? //I//04
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
•
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 #: BLD04-00242 Received Date 4/14/2004
SITE ADDRESS: 3546 THORNDYKE RD Issue Date 4/14/2004
PORT LUDLOW, 98365
APPLICANT: RICHARD WELTER PHONE: (360)297-2365
21238 JEFFERSON BCH RD
KINGSTON WA 98346
2
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 721194003 Section: 19 Township: 27N Range: 01E
CONTRACTOR: C H S PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CHSIN**9790Z Expires 09/06/2004
OWNER,
if different:
PROJECT DESCRIPTION: 500 GAL.ABOVE GROUND PROPANE TANK
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 04/14/2005.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: — /NNk g-XCltA06b- .0K 4119i(/'
[ ] FinalApproval: a)C Zr 4/ /O1/
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
FROM : SOUNDBUILDINGSYSTEMS FAX NO. : 13604371218 Apr. 12 2004 01:44PM P1
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