HomeMy WebLinkAboutBLD2004-00273 0 411
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 #: BLD04-00273 Received Date 4/26/2004
SITE ADDRESS: 154 MAXVIEW DR Issue Date 4/26/2004
PORT LUDLOW, 98365
APPLICANT: PATRICK DRECKMAN PHONE:
MARY DRECKMAN
1626 PEBBLE CHASE DR
KATY TX 77450 1&2
SUBDIVISION: DEPUTY SHORT PLAT Block: Lot:
PARCEL NUMBER: 721093027 Section: 9 Township: 27N 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, PATRICK DRECKMAN PHONE:
if different: MARY DRECKMAN
1626 PEBBLE CHASE DR
KATY TX 77450
PROJECT DESCRIPTION: NO MLA REQ'D - 120 AG PROPANE TANK, HEAT STOVE ZCFP 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 04/26/2005.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: L/NJ/7i"-'/< ,D,t y
[ ] FinalApproval: eg15Yeurr (Fer F.Acr 1NSElerji7 K—ram Tom' I S*
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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
9:\F_BLD_Permit_Propane.rpt 10/29/19c
Ill 'SITE VISIT REPORT GO
(PLOT PLAN)
JOB Mat'l/ )re.r4lkia7/1 DATE :
ADDRESS JOB PHONE #:
FAX
Email
PLANNER: I
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BUILDING PERMIT APPLIC ION BLD04-00273
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00273 Received Date: 4/26/2004
SITE ADDRESS: 154 MAXVIEW DR
PORT LUDLOW, 98365
OWNER: PATRICK DRECKMAN PHONE:
MARY DRECKMAN
1626 PEBBLE CHASE DR
KATY TX 77450
SUBDIVISION: DEPUTY SHORT PLAT Block: Lot: 1&2
PARCEL NUMBER: 721093027 Section: 9 Township: 27 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 DESCRIPTIOt NO MLA REQ'D - 120 AG PROPANE TANK, HEAT STOVE ZCFP 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:
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 By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 CJZ 04/26/04 64189
Total: $48.00
JEFFERSON COUNTf COMMUNIEVELOPMENT,621 SHERIDAN ST,PORT TOWN&WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION .
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* K Above Ground PROPANE TANK* SIZE OF PROPANE TANK /t1- C C1�`-
7C FP J
X HEAT STOVE HOT WATER TANK WOODSTOVE FIREPLACE INSERT • PELLET STOVE
COOKING STOVE r OTHER(Please Specify) 860 ()(
Is this appliance(woodstdve, htg stove, hot water tank,furnace,etc.) to be installed in a Manufactured/Mobile
Home?
YES Y NO
SITE ADDRESS(911#/Road Name):
5 -ti-,�✓t 4 t.J
I. l - - .1J Ltst J ZIP q tr_-3G
9 DIGIT PARCEL ID NUMBER /�� / O G .3 0 7
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT pact (Lie_ 4 11164,64,L, O t Ckl)1C V) PHONE 02c/ " 7K 66 SD-
MAILING ADDRESS 2 ,.,
ZIP
PROPERTY OWNER 4.-4L..c...0 cZ r -}
`�'1 PHONE 0--1)-11�-�C<_,_Z,;
MAILING ADDRESS d-4--C,G-ti._,Uy
ZIP
CONTRACTOR S LA-h S t-{ 01 (-_ (-)r o O d-r,,z___ PHONE
MAILING ADDRESS /nI 0e j13� 1''1aCI Li 0 r' .
Is
P gl
or rr ad L (jc.k, t'v)t1 . ZIP q e.3.3
STATE LICENSE# Slt 11-S N D"] 7 Q 1
EXP.DATE 1 /0 `f ,
FEDERAL I.D.# c I - /'0 7 c 8 5'7
By signing the application form,the applicant/owner attests that the information provided herein is true and correct to the bast 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 Cam.. /i X 14 ,Q..t,-\�- DATE 1/ /21 / G`f
FOR OFFICE USE ONLY
SASE FEE $48.00 RECEIPT# f �.
tK ;0 4
CONSISTENCY REVIEV+J, $24.00 CASH/CK# a a x .
TOTAL '
DATE 1 .� °�''_ ^��*4
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 4 4 4
G:\PermitCenter\FORMS\BLDG FORMS\install-revised 01-26-04.DOC