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HomeMy WebLinkAboutBLD2004-00280 S 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 #: BLD04-00280 Received Date 4/30/2004 SITE ADDRESS: 961 HIDDEN TRAILS RD Issue Date 4/30/2004 PORT TOWNSEND, 98368 APPLICANT: BRUCE A MATLEY PHONE: SUSAN ABRAHAM PO BOX 143 PORT TOWNSEND WA 98368 T 17 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001082008 Section: 8 Township: 30N Range: 01W CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTPI983O6 Expires 09/26/2004 OWNER, BRUCE A MATLEY PHONE: if different: SUSAN ABRAHAM PO BOX 143 PORT TOWNSEND WA 98368 PROJECT DESCRIPTION: NO MLA REQ'D -AG 250 GAL 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 04/30/2005. REQUIRED INSPECTIONS: [LI/ /Line/Appliance: [ ] Fin alApprovaI: 7'/37%/'X 0N4 /4" 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 • BUILDING PERMIT APPLIcrION B Review OOp280 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD04-00280 Received Date: 4/30/2004 SITE ADDRESS: 961 HIDDEN TRAILS RD PORT TOWNSEND, 98368 OWNER: BRUCE A MATLEY PHONE: SUSAN ABRAHAM PC BOX 143 PORT TOWNSEND WA 98368 SUBDIVISION: Block: Lot: T 17 PARCEL NUMBER: 001082008 Section: 8 Township: 30 N Range: 01 W CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTP198306 Expires 09/26/2004 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION NO MLA REQ'D -AG 250 GAL 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 Shoreline Aquifer Forest: Commercial Rural Type Amount Paid By: Date: Receipt: Approved/Date Total: JEFFERSON COUNTY COMM,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 f2 V 0 if,LA; _ riEAT 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): `16I 1rr1ETN I/ IL:i leD poit r 77 WA/ 3C i i) ZIP 1lV/1` L EA, 9 DIGIT PARCEL ID NUMBER 0 01 G 8,a o os Legal Description: Subdivision Name Block Lot(s) Section �/ SUM'1 ,gTownship� North, Range t1 WM APPLICANT ,;��ZUC� M TLG�r 1 JIC.Ii�N /r��C,��;7� PHONE ,3( O/ fig" 8 t i - MAILING ADDRESS o Do' 11/3 \ (� 1" ViL 1 -o ✓)&./L., WA ZIP / 9/G' PROPERTY OWNER 5 44 t PHONE MAILING ADDRESS A��t`� r }-�l �A ZIP CONTRACTOR 1V1 ouiv 4,L/t/ /'1Z.OPA t/E PHONE MAILING ADDRESS /� A l�OKr HAbi©CK , WA ZIP q g 1 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 pfi erty or/structure sha be requested and shall occur during regular business hours. APPLICANTS SIGNATURE �C c% am �,�ll�/lC �c'�L�4 DATE a V / 50 l 79 FOR OFFICE USE ONLY BASE FEE $48.00 RECEIPT# (.A 1 t1 q Q CONSISTENCY REVIEW $24.00 CASH/CK# /01 CD TOTAL DATE/ 3C)/ 0001 * 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 TT q C - - ,_ \ , - x , - I _ 1 7:4 , _ _ _ 1 i art- + - j.... _f/...___,, I 9--'f \ is e _ ® o o 44 rF _ a► N r ( IN ?Li ,. Ac r t _tika,,,,,,i i e.,r"--- ( ‹.--_:_-7--------"L vi 4 / r \ 0.-- ,..c..) ( `-> tIv N/T 7 a co 7- 11 ` ✓ t,-- J F' Pc ( (4._' I 1 `) / ' \� f *l 4 /