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HomeMy WebLinkAboutBLD2004-00371 BLD04-00371 11113UILDING PERMIT APPLICAN Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD04-00371 Received Date: 6/9/2004 SITE ADDRESS: 673 BYWATER WAY N PORT LUDLOW, 98365 OWNER: THOMAS K LEWELLEN PHONE: (206) 365-6721 BARBARA L LEWELLEN 13240 42ND AVE NE SEATTLE WA 98125-4627 SUBDIVISION: WHITE ROCK COVE TRACTS DIV II Block: Lot: 6 PARCEL NUMBER: 821265018 Section: 26 Township: 28 N Range: 01 E CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTP198306 Expires 09/26/2004 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI 500 GALLON ABOVE GROUND PROPANE TANK 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 66364 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* l/ Above Ground PROPANE TANK* SIZE OF PROPANE TANK .. G'C' III/ ✓ HEAT STOVE HOT WATER TANK WOODSTOVE FIREPLACE INSERT PELLETSTOVE 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 v NO SITE ADDRESS(911#/Road Name): 6 7 3 6y 4r,a 1er2 C. Ay A> ;f 0r-r Itt elleev ZIP y�3 C-5- 9 DIGIT PARCEL ID NUMBER P,Z/ .26 S O'`d." Legal Description: Subdivision Name CC,94ia-e f2c411 C©ve .`I Block Lot(s) Section Township North, Range WM APPLICANT / I-C,4L, e//eA PHONE 266. 4?cP 41Se/ MAILING ADDRESS /.3 2 /o y1 r".6W Sere lit coil ZIP pp/2 S PROPERTY OWNER I cy.,.. L.Pry e,Ar..... PHONE 244 ' P 9 so/- MAILING ADDRESS /3 2 YO yZ / 5ecc cvh' ZIP Yd'/2 5 CONTRACTOR A t,..bt,‘ (//.0u CG 57-a ut zo PHONE 36 a E 3.P //6 MAILING ADDRESS 3C 2 7 7- #0-es CA-r0A, 4/vw,. H/A' 50;j/-• WA ZIP Xi- .3 Ye)f i STATE LICENSE# A Q g©(1 CL /1 a/i I-I EXP.DATE is/ S 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'sli ' 'property or st re shall be requested and shall occur during regular business hours. APPLICANTS SIGNATURE __,Li�c 7 --t. ,�-- DATE 6 I Y 1 G'j FOR OFFICE USE ONLY �� `/ BASE FEE $48.00 RECEIPT# 1 6f CONSISTENCY REVIEW $24.00 CASH/CK#le Co / ( 9 �/ TOTAL /�. DATE (O / / / / * Propane Tank applications require additional information to be submitted. OVER Please contact our office at 360-379-4450J if the back of this application is blank. iE)4 /gag'. /Boot.,TAi.:. N/vi/4NE 26 5 eA,-„•.4cr1a„ ✓1v .y/64-/A1 714//I, Po,,t /�a//a-a L i1,"iL G:\PermitCenter\FORMS\BLDG FORMS\install-revised 01-26-04.DOC 410 • 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 #: BLD04-00371 Received Date 6/9/2004 SITE ADDRESS: 673 BYWATER WAY N Issue Date 6/9/2004 PORT LUDLOW, 98365 APPLICANT: THOMAS K LEWELLEN PHONE: (206) 365-6721 BARBARA L LEWELLEN 13240 42ND AVE NE SEATTLE WA 98125-4627 6 SUBDIVISION: WHITE ROCK COVE TRACTS DIV II Block: Lot: PARCEL NUMBER: 821265018 Section: 26 Township: 28N Range: 01 E CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTPI983O6 Expires 09/26/2004 OWNER, THOMAS K LEWELLEN PHONE: (206) 365-6721 if different: BARBARA L LEWELLEN 13240 42ND AVE NE SEATTLE WA 98125-4627 PROJECT DESCRIPTION: 500 GALLON ABOVE GROUND PROPANE TANK 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: rp)'' c4-4—01 [ ] FinalApproval: re) • ;-Z DK crcr 411 Vals1 q/1/06 BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS. 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