HomeMy WebLinkAboutBLD2004-00349 • •
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 #: BLD04-00349 Received Date 5/28/2004
SITE ADDRESS: 630 BACHELOR RD Issue Date 5/28/2004
SEQUIM, 98382
APPLICANT: GARY W DENNIS PHONE:
LORI L DENNIS
PO BOX 1469
SEQUIM WA 983821469 T 30
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 002352026 Section: 35 Township: 30N Range: 02W
CONTRACTOR: ALKI STOVE & SPA PHONE: (360)692-4303
9445 SILVERDALE WAY NW
SILVERDALE WA 98383
OWNER, GARY W DENNIS PHONE:
if different: LORI L DENNIS
PO BOX 1469
SEQUIM WA 983821469
PROJECT DESCRIPTION: WOOD STOVE 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 5/28/2005.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[ ] FinalApprovalg.C...4-24) 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
BUILDING PERMIT APPLIC•ION BLD04-003349
view Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00349 Received Date: 5/28/2004
SITE ADDRESS: 630 BACHELOR RD
SEQUIM, 98382
OWNER: GARY W DENNIS PHONE:
LORI L DENNIS
PO BOX 1469
SEQUIM WA 983821469
SUBDIVISION: Block: Lot: T 30
PARCEL NUMBER: 002352026 Section: 35 Township: 30 N Range: 02 W
CONTRACTOR: ALKI STOVE & SPA PHONE: (360)692-4303
9445 SILVERDALE WAY NW
SILVERDALE WA 98383
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION WOOD STOVE 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:
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: ç/2' F&W Landslide
/()-L( Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 PRB 05/28/04 64513
Total: $48.00
JEFFERSON COUNTY COMA,DEVELOPMENT,621 SHERIDAN ST,PORT TOWD WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TOI THIS INSTALLATION
Underground PROPANE TANK* Above Ground PROPANE TANK* SIZE OF PROPANE TANK
HEAT STOVE HOT WATER TANK X WOODSTOVE FIREPLACE INSERT PELLET STOVE
COOKING STOVE OTHER(Please Specify)
Is this appliance(woodstove, htg stove, hot water tank,furnace,etc.)to be installed in a Manufactured/Mobile
Home?
jel` S y , NO
SITE ADDRESS(911#/Road Name):
6 2Li >,Jc.._G ki..e.. I U Y' R a
P ,w� C� ZIP ci g,j
9 DIGIT PARCEL ID NUMBER Ob2. 5 2.02 b
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT PHONE (3 4,C ) .7, 7-8. ...cic
MAILING ADDRESS
ZIP
PROPERTY OWNER 6 e1,1`N (I,). D-z,-.-- .j ((�) PHONE ('3 C C '7 7-Ste; Q
MAILING ADDRESS Cs, 3�J >?,�iP.L,. ((��e. i d\I" t\r•R
I.ti.:V.A.Se c� ZIP ?'5? :j$
CONTRACTOR A I i Z : 'O'v'e- ` S PP- PHONE ( E 6-O) 6 y 303
MAILING ADDRESS p o Box /c 6
S I I 0-etTc,eL.1 (A e— 7 ZIP / O .-. 3 j
STATE LICENSE# /4 t ICES ES 5 4- 03 O PI Q 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 th
applicant's property or re shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE ��� `�`, 1, 7. DATE . / r57 / c:. `f
FOR OFFICE USE ONLY /��
BASE FEE $48.00 RECEIPT# 51
( ,
'Ll' \
CONSISTENCY REVIEW $24.00 CASH/CK# 3O
TOTAL DATE C/_2O/ 04—
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Propane Tank applications require additional information to be submitted. I OVER Please contact our office at 360-379-4450 if the back of this application is blank.
MAY 2 8 2004 I
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