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Home My WebLink AboutBLD2004-00291 # a 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 #: BLD04-00291 Received Date 5/5/2004 SITE ADDRESS: 61 GALLOWAY LN Issue Date 5/5/2004 BRINNON, 98320 APPLICANT: DIANE DERRICK PHONE: OLIVIA ALFANO 61 GALLOWAY LN BRINNON WA 983209769 SUBDIVISION: Block: Lot: PARCEL NUMBER: 601182008 Section: 18 Township: 26N Ranqe: 01W CONTRACTOR: FERRELL GAS PHONE: 360-877-5311 P 0 BOX 67 HOODSPORT WA 98548 Contractor's License FERRELP055LH Expires 08/01/2004 OWNER, DIANE DERRICK PHONE: if different: OLIVIA ALFANO 61 GALLOWAY LN BRINNON WA 983209769 PROJECT DESCRIPTION: PROPANE TANK INSTALLATION 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 05/05/2005. REQUIRED INSPECTIONS: [P( Tank/Lin:/Appliance: [' FinalApproval: //3`o, 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 10/29/19 L II BUILDING PERMIT APPLICION D04-00291 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD04-00291 Received Date: 5/5/B2004 SITE ADDRESS: 61 GALLOWAY LN BRINNON, 98320 OWNER: DIANE DERRICK PHONE: OLIVIA ALFANO 61 GALLOWAY LN BRINNON WA 983209769 SUBDIVISION: Block: Lot: PARCEL NUMBER: 601182008 Section: 18 Township: 26 N Range: 01 W CONTRACTOR: FERRELLGAS PHONE: (360)582-0231 646 SO 3RD AVE SEQUIM WA 98382 Contractor's License FERRELP055LH Expires 8/1/2004 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI PROPANE TANK INSTALLATION 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 ��) �.,C7 04?-2 Shoreline Aquifer Forest: Commercial Rural Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $48.00 PRE 05/05/04 64328 Total: $48.00 JEFFERSON COUNTY COMMO 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 z So GA L. 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): (21 6ALLQ /A1 L I 13RI (4100/Q + - ZIP 82.0 9 DIGIT PARCEL ID NUMBER Go 1 1 g2 d O g Legal Description: Subdivision Name Block Lot(s) Section Township North, Range WM APPLICANT 'DIANE 'DErtJltc c./Li vlA ALFAMo PHONE 360 -19 Is -3570 MAILING ADDRESS (09I 4JAL�AW�Ay LN atN^Jok.1 ZIP 232o PROPERTY OWNER SA-A4C PHONE MAILING ADDRESS ZIP CONTRACTOR FEftRe LL, 6/4 S, PHONE MAILING ADDRESS E%cols 1 a 2-r ZIP STATE LICENSE# 2rrL9C)55"L4- 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.APPLICANT'S SIGNATURE bt4t14 GIAAA !S. DATE 5- / / 0'1 FOR OFFICE USE ONLY �,J,2 Q BASE FEE $48.00 RECEIPT# t� l 2- CONSISTENCY REVIEW $24.00 CASH/CK# 12 32 ,( TOTAL 1Z. DATE SS/ 5 / D�F. 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 • • 1 I n cx-,r\i N `00 •