HomeMy WebLinkAboutBLD2004-00335 • •
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 #: BLD04-00335 Received Date 5/24/2004
SITE ADDRESS: 55 CEDARVIEW DR Issue Date 5/24/2004
PORT TOWNSEND, 98368
APPLICANT: JON K FOX PHONE:
PATRICIA L FOX
55 CEDAR VIEW DR
PORT TOWNSEND WA 983682502 204
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 965000344
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP"077QP Expires 11/17/2004
OWNER, JON K FOX PHONE:
if different: PATRICIA L FOX
55 CEDAR VIEW DR
PORT TOWNSEND WA 983682502
PROJECT DESCRIPTION: NO MLA REQ'D -GAS PIPE, GAS STOVE MOVEMENT&
REVENTING
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 05/24/2005.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[ ] FinalApproval:
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
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O BUILDING PERMIT APPLIC' 'ION BL v
Reviewiew T Ty335
ype:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00335 Received Date: 5/24/2004
SITE ADDRESS: 55 CEDARVIEW DR
PORT TOWNSEND, 98368
OWNER: JON K FOX PHONE:
PATRICIA L FOX
55 CEDAR VIEW DR
PORT TOWNSEND WA 983682502
SUBDIVISION: Block: Lot: 204
PARCEL NUMBER: 965000344 Section: Township: Range:
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 - GAS PIPE, GAS STOVE MOVEMENT & REVENTING
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 Bv: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 CJZ 05/24/04 64446
Total: $48.00
JEFFERSON COUNTY COMMUNIT EVELOPMENT,621 SHERIDAN ST,PORT TOWNS WA 98368 PH: (360)379-4450
TALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION -- —
n ;r
Underground PROPANE TANK* Above Ground PROPANE TANK* SIZE OF PROPANE TANK '� - •
HEAT STOVE HOT WATER TANK WOODSTOVE FIREPLACE INSERT PELLET S F
COOKING STOVE /\ OTHER(Please Specify) (� E l D�a v ryf p v eyrr� Az.-1✓
Is this appliance(woodstove,htg stove, hot water tank,furnace, etc.)to be installed in a Manufactured/Mobile
Home? -
YES X NO
SITE ADDRESS(911#/Road Name):
� Co/
S V d V i_.ru 3 6 r.
Pdyii l 00.)fis ZIP 0toG '
9 DIGIT PARCEL ID NUMBER 965 600 s y/
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT �J 0, 4 Pc V PHONE 31
MAILING ADDRESS �5
ZIP
PROPERTY OWNER e PHONE C,41
4 o
MAILING ADDRESS ali--C_Gl
ZIP �°
CONTRACTOR S LA Y) S 1-} I V'1 f-• Pr G p� ,h _ PHONE 2GiJ J ,S 7? /
MAILING ADDRESS I ' a13� tC�"loc{Li r"
Pori" t�1�d 1~ dc..14 ZIP q e33�]
STATE LICENSE# 'L 1-S(-I P (c)~7 7 Q A EXP.DATE I I/0
FEDERAL I.D.# -I 1 - 10 7 c 8 s n7
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`._ ti,vim L1 U Z DATE S / / O
FOR OFFICE USE ONLY
E FEE 0 � $48.00 'x �
' RECEIPT#
8ISTENCY IOW p �
CASH/CK
'•. TOTAL �" ��'4
DATE 4<a. tt
Propane Tank applications require additional information to be submitted. OVER I�
Please contact our office at 360-379-4450 if the back of this application is blank. U V
G:\PermitCenter\FORMS\BLDG FORMS\install-revised 01-26-04.DOC