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Home My WebLink AboutBLD2004-00316 II BUILDING PERMIT APPLITION BLD04 0033we16 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD04-00316 Received Date: 5/14/2004 SITE ADDRESS: 991 LUDLOW BAY RD PORT LUDLOW, 98365 OWNER: ROBERT J BRADLEY PHONE: 991 LUDLOW BAY RD PORT LUDLOW WA 983658731 SUBDIVISION: LUDLOW BEACH TRS 2 Block: 2 Lot: 19 PARCEL NUMBER: 969000020 Section: 16 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 DESCRIPTION NO MLA REQ'D -AG 120 GAL PROPANE TANK, HEATING STOVE, 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: 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 Propane Tanks/Stoves $48.00 CJZ 05/14/04 64428 Total: $48.00 O 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 #: BLD04-00316 Received Date 5/14/2004 SITE ADDRESS: 991 LUDLOW BAY RD Issue Date 5/14/2004 PORT LUDLOW, 98365 APPLICANT: ROBERT J BRADLEY PHONE: 991 LUDLOW BAY RD PORT LUDLOW WA 983658731 19 SUBDIVISION: LUDLOW BEACH TRS 2 Block: 2 Lot: PARCEL NUMBER: 969000020 Section: 16 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, ROBERT J BRADLEY PHONE: if different: 991 LUDLOW BAY RD PORT LUDLOW WA 983658731 PROJECT DESCRIPTION: NO MLA REQ'D -AG 120 GAL PROPANE TANK, HEATING STOVE, 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 05/14/2005. REQUIRED INSPECTIONS: [ ] Tank/Line/Appliance;2C-- [ ] FinalApproval: c_`-14( 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. • JEFFERSON COUNTY COMMUNIT DEVELOPMENT,621 SHERIDAN ST,PORT TOWNS D WA 98368 PH: (350)379-4450 STALLATION PERMIT APPLIC ATIO MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION / Underground PROPANE TANK* 1� Above Ground PROPANE TANK* SIZE OF PROPANE TANK HEAT STOVE HOT WATER TANK WOODSTOVE FIREPLACE INSERT • PELLET STOVE ,/ COOKING STOVE �TOTHER(Please Specify) ' {O V"L- yr � .4s P (� Is this appliance(woodst4ve,htg stove, hot water tank,furnace,etc.) to be installed in a Manufactured/Mobile !forme? YES C7- NO SITE ADDRESS(911#/Road Name): q q ( 2 4 z✓ G � 1 � �T �: ZIP 9 DIGIT PARCEL ID NUMBER q I Coo Legal Description: Subdivision Name Block Lot(s) Section Township North, Range WM APPLICANT ep(c � PHONE/ a_� 7 -,1 7� MAILING ADDRESS ( i 9 ( -�-:iy,J -e t 1 i(2-0 ZIP PROPERTY OWNER -L-1.— a-4 4 PHONE rJ pJ —e'L+ MAILING ADDRESS 6 F ZIP CONTRACTOR S LA-h 5 I4 i i1 Q- Pr C i s _ PHONE S 57 jC7 MAILING ADDRESS I Cie 5 3 {�koci 6 r Por r '‘lad Lock tJ fl . ZIP ci e33 STATE LICENSE# 34hSH-P CD`J 7 Q A EXP.DATE ) t/O `f FEDERAL I.D.# /o ']C] S r 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 C� ( r Q Th DATE =' I P/ I a I FOR OFFICE USE ONLY $48.00 BASE FEE RECEIPT# � ��:_ 44, rQNsl$T�Y �IEw,< $24.00 '' CASH/CK# �t 1 TOTAL • ' ,...';' Propane Tank applications require additional information to be submitted. OVER Please contact our office at 360-3i79.4450 if the back of this application is blank. G:\PermitCenter\FORMS\BLDG FORMS\install-revised 01-26-04,DOC i _ y i SITE VISIT REPORT • (PLOT PLAN) JOB 8 / � (y _ DATE : 1/� fi ADDRESS 1 JOB PHONE #: FAX #: Email PLANNER: —, — 1 • i G/Oer(S76acI Gt of e - PRoP GWei: • tom' % 4 Pa IX Ga- Wct le c- l' POWC-r .,- _ I _ /,--- ` /'�ilif A7e76'/ wad 0 ix Offc'e._ , ,,,,, lr I r i v I1 t. � i i1� F/rli7�( aeemwr LJ I I 1 II Comments: -I'/",-- A E 4 y , ill v.fl 656 5 ; X R 'Mfilt llt\dee. Ian; (-(51t -.010;4 ( h'e \it bfri" frellS °iN,, 1180tX,, Ott( GCQ/z t R 4i tfii t34 -( ;t vL, 15' 67 Volt9t tit Az,,,,,wz` ,