HomeMy WebLinkAboutBLD2004-00370 • 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 #: BLD04-00370 Received Date 6/9/2004
SITE ADDRESS: 374 OLD GARDINER RD Issue Date 6/9/2004
SEQUIM, 98382
APPLICANT: TRACY NELSON PHONE:
151 PARADISE LN
SEQUIM WA 983829012
T 52
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 002332018 Section: 33 Township: 30N Range: 02W
CONTRACTOR: A W G CONSTRUCTION PHONE: (360)683-2246
151 PARADISE LN
SEQUIM WA 98382
Contractor's License AWGCO**017L8 Expires 08/19/2004
OWNER, TRACY NELSON PHONE:
if different: 151 PARADISE LN
SEQUIM WA 983829012
PROJECT DESCRIPTION: HEAT STOVE, COOKING 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: �1//9.t&
,/‘k
[ ] FinalApproval\ 3"/11? 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
I:\F_BLD_Permit_Propane.rpt 10/29/19
libUILDING PERMIT APPLIC ON BLD04-00370
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00370 Received Date: 6/9/2004
SITE ADDRESS: 374 OLD GARDINER RD
SEQUIM, 98382
OWNER: TRACY NELSON PHONE:
151 PARADISE LN
SEQUIM WA 983829012
SUBDIVISION: Block: Lot: T 52
PARCEL NUMBER: 002332018 Section: 33 Township: 30 N Range: 02 W
CONTRACTOR: A W G CONSTRUCTION PHONE: (360)683-2246
151 PARADISE LN
SEQUIM WA 98382
Contractor's License AWGCO**017L8 Expires 08/19/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION HEAT STOVE, COOKING 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 By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 ZAN 06/09/04 66363
Total: $48.00
JEFFERSON COUNTY COMMUIJEVELOPMENT,621 SHERIDAN ST,PORT TOWI D WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
coxStiAn �)0 4v.¢ -CcA Gill 17 pew c/ri1
Axet
Underground PROPANE TANK* Above Ground PIbPANE TANK* SIZE OF PROPANE TANK i
It 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):
3-1'4 0\ k C- r`O r r
5"t' V� — Ai " ZIP 7&3�
9 DIGIT PARCEL ID NUMBER CV 3. ,,, di
Legal Description: /
Subdivision Name Block Lot(s) / ` 2_
Section 3 Township SO North, Range C0 2 WM
APPLICANT I CO el ,k n PHO E,30(J/? )-cx� I
MAILING ADDRESS 3-AI V(4 5ar d mire cc it L
Seribu �� LEA/1 - Si ZIP _. /
PROPERTY OWNER �� VGy ► I1 .. ,/� PHONU 7? 7 _ /
MAILING ADDRESS , ) ( V l � 'Q(4 v vx A- /C.
S4p., v\- '-� ZIP 3
CONTRACTOR /lam` G�C. ����`�` PHON C,� 02 `-C
MAILING ADDRESS / / ���C di P �� `'
7,-,_ -z„,z " 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 applicant's property or structure shall be requested and shall occur during regular business hours.
N.
APPLICANTS SIGNATURE ,/ -��h I `= t DATE,/. / .(, / :ram~
FOR OFFICE USE ONLY
BASE FEE $48.00 RECEIPT# (C,63
CONSISTENCY REVIEW . CASH/CK# 21 Q�0
Q
TOTAL A p 7 DATE (0_/ ( /Y
Propane Tank applications require additional information to be submitted. OVER Please contact our office at 360-379- 450 if the back of this application is blank.
JUN - 9 2004
G:\PermitCenter\FORMS\BLDG FORMS\install-revised 01-26-04.DOC .- ' ' -