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HomeMy WebLinkAboutBLD2004-00368 • S 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#: BLD04-00368 Received Date 6/8/2004 SITE ADDRESS: 477 N JACOB MILLER RD Issue Date 6/8/2004 PORT TOWNSEND, 98368 APPLICANT: PAUL D SAASTAD PHONE: N I NA E SAASTAD 477 N JACOM MILLER RD PORT TOWNSEND WA 983689649 1 SUBDIVISION: RHOADES/CARROLL SHORT PLAT Block: Lot: PARCEL NUMBER: 001051021 Section: 5 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, PAUL D SAASTAD PHONE: if different: NINA E SAASTAD 477 N JACOM MILLER RD PORT TOWNSEND WA 983689649 PROJECT DESCRIPTION: 500 GALLON UNDERGROUND PROPANE TANK AND 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 06/08/2005. REQUIRED INSPECTIONS: [ ] Tank/Line/Appliance: [ FinalApproval:c C � - .I (9 D y t. 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 11F_BLD_Permit_Propane.rpt 10/29/19 UILDING PERMIT APPLICA i ION BLD04 003368 w Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD04-00368 Received Date: 6/8/2004 SITE ADDRESS: 477 N JACOB MILLER RD PORT TOWNSEND, 98368 OWNER: PAUL D SAASTAD PHONE: NINA E SAASTAD 477 N JACOM MILLER RD PORT TOWNSEND WA 983689649 SUBDIVISION: RHOADES/CARROLL SHORT PLAT Block: Lot: 1 PARCEL NUMBER: 001051021 Section: 5 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 500 GALLON UNDERGROUND PROPANE TANK AND 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: b/s;;, /� F&W Landslide 7 Shoreline Aquifer Forest: Commercial Rural Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $48.00 ZAN 06/08/04 66360 Total: $48.00 JEFFERSON COUNTY COMMUNI•EVELOPMENT,621 SHERIDAN ST,PORT TOWN.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 4-D C3 0 P`"(— 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): 7/-7 Aiod-4x. 4-w, Ts c-Kj ZIP 7 9 DIGIT PARCEL ID NUMBER © © I T < ( Q 2- Legal Description: / Subdivision Name D49-'De S Otiz/2_(5,L L ?Cr% Pk_A ) Block Lot(s) Section Township North, Range WM APPLICANTL, . l°t-S 1� PHONE coo "S"--) /L1 O MAILING ADDRESS T 7 7 Ai _/ 7 ' 0' `7/l/y/Pik-. (`C :74 72-% c.,c)i L 4-1 77 11J s Q ZIP P PROPERTY OWNER :5; M ? IP??/ PHONE MAILING ADDRESS ZIP CONTRACTOR C N° - /'r o`� fi PHONE 5 MAILING ADDRESS C t9 N( �{ - ( ( c/ 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 righ try to Jefferson Countyad-it's-empl ees,representatives or agents for the purpose of application review and any required later inspections. Access and right of entry applicant's propedyorf} str cture sha a requested and shall occur during regular business hours. APPLICANTS SIGNATURE f e--. , ' - v e"=- z—c DATE `�' / ° / c)/— FOR OFFICE USE ONLY BASE FEE $48.00 RECEIPT# CONSISTENCY REVIEW $24.00 CASH/CK# TOTAL DATE / / 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. 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