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HomeMy WebLinkAboutBLD2004-00379 •UILDING PERMIT APPLICI DN B Review Type: y pe: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD04-00379 Received Date: 6/11/2004 SITE ADDRESS: 57 HUNT RD PORT HADLOCK, 98339 OWNER: LUTHER E BLAND SR PHONE: KARLA J BLAND 4327 N JEFFERSON ST SPOKANE WA 992051210 SUBDIVISION: CHALMER'S 2ND ADDITION Block: 35 Lot: 1-7 PARCEL NUMBER: 942903502 Section: 3 Township: 29 N Range: 01 W 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 250 ABOVE GROUND PROPANE TANK AND PIPING TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 1997 HEAT BASE: HEAT TYPE: OCCUPANCY: 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 (/ oy Shoreline Aquifer Forest: Commercial Rural 1. Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $48.00 ZAN 06/11/04 66370 Total: $48.00 • 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 #: BLD04-00379 Received Date 6/11/2004 SITE ADDRESS: 57 HUNT RD Issue Date 6/11/2004 PORT HADLOCK, 98339 APPLICANT: LUTHER E BLAND SR PHONE: KARLA J BLAND 4327 N JEFFERSON ST SPOKANE WA 992051210 1-7 SUBDIVISION: CHALMER'S 2ND ADDITION Block: 35 Lot: PARCEL NUMBER: 942903502 Section: 3 Township: 29N Range: 01W CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTP198306 Expires 09/26/2004 OWNER, LUTHER E BLAND SR PHONE: if different: KARLA J BLAND 4327 N JEFFERSON ST SPOKANE WA 992051210 eeJJ PROJECT DESCRIPTION: 250 ABOVE GROUND PROPANE TANK AND PIPING 4- Item- Ne 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 06/11/2005. REQUIRED INSPECTIONS: [ ] Tank/Line/Appliance: EXT GAS Lwue—TESTED 8Y Mok.iarA,a lizcrA►lh- - [ ] FinalApproval: i�. ' Ou 1 , 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 JEFFERSON COUNTY COMMUNEVELOPMENT,621 SHERIDAN ST,PORT TOWN D WA 98368 PH: (360)379-4450 INSTALLATION PERMIT APPLICATION MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION r�) �^ Undergroundun� PROPANE TANK* )( Above Ground PROPANE TANK* SIZE OF PROPANE TANK 02 VLc,1' > HEA-PSTrrOVE 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? K" YES NO SITE ADDRESS(911 #/Road Name): 5-'1 n1- 0 'Pe.4 c(f 0 C(c , C, ),9- ZIP 90 .3 3? 9 DIGIT PARCEL ID NUMBER 'p92 91, 3 _o)._ Legal Description: Subdivision Name Block Lot(s) =fv-- 7 Section Township North, Range WM APPLICANT N C H V i`"IIGc 1(€ A ci PHONE 3 p s t ©7 MAILING ADDRESS..?.0 Cl,4 P2 r Cv :ti Gt c_cri F-, f t.CJ77 ZIP 9e ;?-s PROPERTY OWNER c PHONE MAILING ADDRESS ZIP CONTRACTOR fridLc n lit t 7,eig7a rh a PHONE 1 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,f entry to Jefferson Count nd it's emplo ees,representatives or agents for the purpose of application review and any required later inspections. Access and right of entry to e lica 's propr r ruct hall r quested and shall occur during regular business hours. APPLICANTS SIGNATURE a°) DATE,/n / // /0 i FOR OFFICE USE ONLY BASE FEE $48.00 RECEIPT# CONSISTENCY REVIEW $24.00 CASH/CK# TOTAL 7 - �' 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 • cur?y • Acij Dry, ca rs • v�G ()'-'\