HomeMy WebLinkAboutBLD2004-00369 • BUILDING PERMIT APPLI ION Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00369 Received Date: 6/9/2004
SITE ADDRESS: 180 BLACK BEAR RD
PORT TOWNSEND, 98368
OWNER: RANDALL J LECHTENBERG PHONE:
LEA LECHTENBERG
PO BOX 282
PORT HADLOCK WA 983390282
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 001321028 Section: 32 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 DESCRIPTIOr NO MLA REQ'D - 250 GAL AG 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:
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 06/09/04 66277
Total: $48.00
0 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 #: BLD04-00369 Received Date 6/9/2004
SITE ADDRESS: 180 BLACK BEAR RD Issue Date 6/9/2004
PORT TOWNSEND, 98368
APPLICANT: RANDALL J LECHTENBERG PHONE:
LEA LECHTENBERG
PO BOX 282
PORT HADLOCK WA 983390282
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 001321028 Section: 32 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, RANDALL J LECHTENBERG PHONE:
if different: LEA LECHTENBERG
PO BOX 282
PORT HADLOCK WA 983390282
PROJECT DESCRIPTION: NO MLA REQ'D -250 GAL AG PROPANE TANK& HEAT STOVE
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 06/09/2005.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: , "02-1`01(
[Ian FinalApproval L.-3, 2 J,� (
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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1116,_ JEFFERSON COUNTY COMM,Y DEVELOPMENT,621 SHERIDAN ST,PORT TO•ND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TOTHIS INSTALLATION
/O Underground PROPANE TANK* Above Ground PROPANE TANK* SIZE OF PROPANE TANK 'S0
?CHEAT 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):
Pe ITT o tx3 ti\ e_y��� v)A ZIP ?83U!
9 DIGIT PARCEL ID NUMBER DV/3 oZ/Oca 2
Legal Description:
Subdivision Name Block Lot(s)
Section /* Township North, Range WM
APPLICANT KAnO/� T 2e AY\ k r, PHONE 3? S"— 7/
MAILING ADDRESS /;O j A OKj d?8'D?pe r—f 14//,A4 tO c k r_ /AJ i� ZIP 9.n 3
PROPERTY OWNER Ailc17, Are `1 'I'� >k7'Ir ``�7 PHONE 37?—.S 9/
MAILING ADDRESS AtO, ///S OX .2 82-
Pert t-kwi)o C k b1 a ZIP 98. 3
CONTRACTOR nie,LL*l+et h tQAh'e
P n PHONE s "CP.2
a MAILING ADDRESS aces— c / 1 p 1 m Ct t tkW k..b
Pod-Aw \0 t 1� (A) ZIP qa 3
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 theeaa licant's property orsst`rruuccttu shall r ested an hall occur during regular business hours.
APPLICANTS SIGNATURE T/4� r/�'— ��` DATE l / 8. / O y
FOR OFFICE USE ON
BASE FEE $48.00 RECEIPT#
CONSISTENCY REVIEW $24.00 CASH/CK# O. 1\50 C
TOTAL r O 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.
G:\PermitCenter\FORMS\BLDG FORMS\install-revised 01-26-04.DOC