HomeMy WebLinkAboutBLD2004-00249 BUILDING PERMIT APPLICA4N Review Type:
Jefferson County Department of Community Development BLD04-00249
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00249 Received Date: 4/20/2004
SITE ADDRESS: 21A S KEEL WAY
PORT LUDLOW, 98365
OWNER: JON E OLSEN PHONE:
BARBARA J LANDI
PO BOX 244061
ANCHORAGE AK 995244061
SUBDIVISION: INNER HARBOR VILLAGE CONDO Block: Lot:
PARCEL NUMBER: 961601601 Section: 17 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 DESCRIPTIOI NO MLA REQ'D - 120 GAL AG PROPANE TANK, PIPING, FIREPLACE,
T FOR BBQ
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
Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Total:
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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 #: BLD04-00249 Received Date 4/20/2004
SITE ADDRESS: 21A S KEEL WAY Issue Date 4/20/2004
PORT LUDLOW, 98365
APPLICANT: JON E OLSEN PHONE:
BARBARA J LANDI
PO BOX 244061
ANCHORAGE AK 995244061
SUBDIVISION: INNER HARBOR VILLAGE CONDO Block: Lot:
PARCEL NUMBER: 961601601 Section: 17 Township: 28N 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
OWNER, JON E OLSEN PHONE:
if different: BARBARA J LANDI
PO BOX 244061
ANCHORAGE AK 995244061
PROJECT DESCRIPTION: NO MLA REQ'D - 120 GAL AG PROPANE TANK, PIPING,
FIREPLACE, T FOR BBQ
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 04/20/2005.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: C7676t-
[ ] FinalApproval: -f S- a.2
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 10/29/19c
.,, JEFFERSON COUNTY COMMUNITY giELOPMENT,621 SHERIDAN ST.PORT TOWNSEN A; F. (Q¢Q)Fit/9-4145dI ti0" _v- 1
INALLATION PERMIT APPLICATION t 't i .. .',
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION I 1" `1 I t
Underground PROPANE TANK* Above Ground PROPANE TANK* SIZE OF PROPANE TANK rl`✓ j. -
i
HEAT STOVE HOT WATER TANK WOODSTOVE FIREPLACE INSERT • PELLET STOVE �, pM`,.`
COOKING STOVE OTHER(Please Specify) V c`-1 r �-, -V`PT_OF Cy,:` ___v E 0
Is this appliance(woodstove, htg stove, hot water tank,furnace,etc.) to be installed in a Manufactured/Mobile
Horne?
YES V NO
SITE ADDRESS(911#/Road Name): 5 D j n e 6.1,,e_,T id r c1 •
r( . (ck ZIP ��J Cd)
9 DIGIT PARCEL ID NUMBER Cl 3 1 1 ( G 0 0 J •
Legal Description:
Subdivision Name - Block Lot(s)
Section Township North, Range WM
c p 7_ /
APPLICANT G,, - ^r J,-,-r-..) i- r lC--r-� P-c PH
.)G"C ONE 7 .2 Z o
MAILING ADDRESS .,
ZIP
PROPERTY OWNER lig-4A c a 44 PHONE cliji, '4.--rb
MAILING ADDRESS a 1 t-c-4-r-:Ld
ZIP
CONTRACTOR S iA-h 5 14 IV) .f_ Pc c p a/�4._ PHONE .
S�J IC MAILING ADDRESS 10
3 kocl_c...t ►Jr, g
I'ef`T1 �d �_cc-k, v wf 1 ZIP q 0,3.3
STATE LICENSE# 3411 Si 1-I19 6) 7 7 Q P EXP.DATE II/0 "(
FEDERAL I.D.# . ci I - 4a 7 i 8S'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.
r
I further agree to save,indemnify and hold harmless Jefferson County against ail 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 4
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 Cam. ( In-r,-✓J .0-1 \_____ DATE L f I /3 / 0
T. FOR OFFICE USE ONLY
BASE FEE , $48.00 RECEIPT# 64111 . t
,,
$ :
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�NSi�T t�nr;fi_ $24.00 ca,sHicK� �
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.
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