HomeMy WebLinkAboutBLD2004-00252 BUILDING PERMIT APPLIC ION BLD04-002252
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Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00252 Received Date: 4/20/2004
SITE ADDRESS: 6062 SR 20#58
PORT TOWNSEND, 98368
OWNER: LARRY G ENNEN PHONE:
ROSEMARIE ENNEN
15825 40TH PL S APT 104
TUKWILA WA 981885656
SUBDIVISION: OLYMPIC MOBILE VILLAGE IMPS ON Block: Lot:
PARCEL NUMBER: 978706058 Section: 33 Township: 30 N Range: 01 W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPI98306 Expires 9/26/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr PROPANE TANK INSTALLATION
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 1997 HEAT BASE: HEAT TYPE:
OCCUPANCY:
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: /,, 21DI/ F&W Landslide
+T oct Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 PRB 04/19/04 64303
Total: $48.00
- JEFFERSON COUNTY COMMY DEVELOPMENT,621 SHERIDAN ST,PORT TO•ND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
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.Ia.Manufactured/Mobile
Home?
YES NO
SITE ADDRESS(911#/Road Name):
4'49@ Z Lit 2(C) = G • APR 1 9 2004
_ ZIP ,
9 DIGIT PARCEL ID NUMBER q'7 F 7
Legal Description:
Subdivision Name Block Lot(s)
Section�� g Township North, Range WM
APPLICANT / ),4/Z t( ��- CU /U ik) PHONE-Zp 0 ( 9 9
MAILING ADDRESS 6 Co) . a) A qC)
�� (; ZIP
PROPERTY OWNER,. e-�' '" �v�_� PHONE
MAILING ADDRESS
ZIP
CONTRACTOR ) (, '' f�G�;/ a. 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 applicant's property or structure shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE DATE / /
FOR OFFICE USE ONLY
BASE FEE $48.00 RECEIPT# �� �p3
CONSISTENCY REVIEW $24.00 CASH/CK# Ci\3 F"J
TOTAL DATE / l /0
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
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 #: BLD04-00252 Received Date 4/20/2004
SITE ADDRESS: 6062 SR 20#58 Issue Date 4/20/2004
PORT TOWNSEND, 98368
APPLICANT: LARRY G ENNEN PHONE:
ROSEMARIE ENNEN
15825 40TH PL S APT 104
TUKWILA WA 981885656
SUBDIVISION: OLYMPIC MOBILE VILLAGE IMPS ON Block: Lot:
PARCEL NUMBER: 978706058 Section: 33 Township: 30N Range: 01W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPI983O6 Expires 9/26/2004
OWNER, LARRY G ENNEN PHONE:
if different: ROSEMARIE ENNEN
15825 40TH PL S APT 104
TUKWILA WA 981885656______ _
PROJECT DESCRIPTION: PROPANE TANK INSTALLATION-7
THIS PERMIT IS VALID FOR ONE YEAR AND IS NOT RENEWABLE.
THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WI THIN THAT YEAR.
THE EXPIRATION DATE IS 4/20/2005.
REQUIRED INSPECTIONS:
[ ] Tank/ . e/Appliance:
[ ] FinalApprovalr 5!Vy,
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_Pe rm it_P ropa ne.rpt 10/29/19
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