HomeMy WebLinkAboutBLD2004-00356 e •
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 #: BLD04-00356 Received Date 6/3/2004
SITE ADDRESS: 3391 HASTINGS AVE W Issue Date 6/3/2004
PORT TOWNSEND, 98368
APPLICANT: WILLIAM BRAYTON PHONE:
2023 E SIMS WAY#199
PORT TOWNSEND WA 98368
SUBDIVISION: COOK SHORT PLAT Block: Lot:
PARCEL NUMBER: 001064023 Section: 6 Township: 30N Range: 01W
CONTRACTOR: C H S PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CHSIN**9790Z Expires 09/06/2004
OWNER, PHYLLIS M BRAYTON TRSTE PHONE:
if different: P M BRAYTON LIVING TRUST
1508 BRAYTON AVENUE
ESCALON CA 95320
PROJECT DESCRIPTION: NO MLA REQ'D -AG 200 GALLON PROPANE TANK&i-'i'i!ATSTOVE
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 06/03/2005.
REQUIRED INSPECTIONS:
)t-
[ ] Tank/Line/Appliance: I *. 0,9
(....,
[ ] FinalApproval: ( ArlIc. I'b^2,7-03,
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 APPLIL Review T TyION BL y356
pe:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00356 Received Date: 6/3/2004
SITE ADDRESS: 3391 HASTINGS AVE W
PORT TOWNSEND, 98368
OWNER: WILLIAM BRAYTON PHONE:
2023 E SIMS WAY#199
PORT TOWNSEND WA 98368
SUBDIVISION: COOK SHORT PLAT Block: Lot:
PARCEL NUMBER: 001064023 Section: 6 Township: 30 N Range: 01 W
CONTRACTOR: C H S PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CHSIN**9790Z Expires 09/06/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP NO MLA REQ'D -AG 200 GALLON PROPANE TANK & HEAT STOVE
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: F&W Landslide
Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid Bv: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 CJZ 06/03/04 66262
Total: $48.00
JEFFERSON COUNTY COMMA,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
yt Underground PROPANE TANK* X` Above Ground PROPANE TANK* SIZE OF PROPANE TANK 0 0
/) 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 \4, NO
SITE ADDRESS(911#/Road Name):
3 3 4/ tYA-s�-�-,.�y s A4r._. CO
1 O ..n.1.ice+ C ZIP g 8 3 6 g
9 DIGIT PARCEL ID NUMBER U O l O C-Y 02. 3
Legal Description: C S Subdivision Name �2'f'- pb1_/ r Block Lot(s) .��
Section le Township .30 1f North, Range I w WM
APPLICANT A)(7 i41%L. /2-•is f - PHONE 3g 5 ---1 sr3 7
MAILING ADDRESS a-CU 2.3 E S/r►t S to #ff
Pouf G4,14u.. ZIP ?2368
PROPERTY OWNER SIFM., 44-5 /440CPL PHONE
MAILING ADDRESS
ZIP
CONTRACTOR t C PHONE
MAILING ADDRESS
ZIP
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 pli n' property or sttruct shall requested and shall occur during regular business hours.
SIGNATURE WL^� - PIT DATE 4, / Z / Z ac c,/
FOR OFFICE USE ONLY �����
BASE FEE $48.00 RECEIPT#
CONSISTENCY REVIEW $24.00 CASH/CK# /Ct�
TOTAL la .0 0 DATE (O ,a /Peozk
*
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
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