HomeMy WebLinkAboutBLD2004-00386 • BUILDING PERMIT APPLICCION B Review
003386
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00386 Received Date: 6/14/2004
SITE ADDRESS: 262 MARGARET ST
PORT LUDLOW, 98365
OWNER: JANET L STIMACH PHONE:
1920 S SPOKANE ST
SEATTLE WA 981446730
SUBDIVISION: Block: Lot: T 81
PARCEL NUMBER: 821333028 Section: 33 Township: 28 N Range: 01 E
CONTRACTOR: EMERALD HEARTH AND HOME PHONE: (360)779-7567
20714 SR 305
POULSBO WA 98370
Contractor's License EMERAHH975P0 Expires 10/20/2005
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr INSTALLATION OF PROPANE FIREPLACE AND UNDERGROUND
LINE.
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 1997 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: 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: / ((cf F&W Landslide
V 1 �� ��"��"" Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 PRB 06/14/04 64531
Total: $48.00
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 #: BLD04-00386 Received Date 6/14/2004
SITE ADDRESS: 262 MARGARET ST Issue Date 6/14/2004
PORT LUDLOW, 98365
APPLICANT: JANET L STIMACH PHONE:
1920 S SPOKANE ST
SEATTLE WA 981446730
T 81
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 821333028 Section: 33 Township: 28N Range: 01 E
CONTRACTOR: EMERALD HEARTH AND HOME PHONE: (360)779-7567
20714 SR 305
POULSBO WA 98370
Contractor's License EMERAHH975PO Expires 10/20/2005
OWNER, JANET L STIMACH PHONE:
if different: 1920 S SPOKANE ST
SEATTLE WA 981446730
PROJECT DESCRIPTION: INSTALLATION OF PROPANE FIREPLACE AND UNDERGROUND
LINE.
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 6/14/2005.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: C)C—t.iN,c, 6-0-0 y
[ ] FinalApproval: "Z—aft—bS
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
6:\F_BLD_Permit_Propane.rpt 10/29/19
JEFFERSON COUNTY COMMUNITOVELOPMENT,621 SHERIDAN ST,PORT TOWNSEOVVA 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
HEAT STOVE HOT WATER TANK WOODSTOVE FIREPLACE INSERT PELLET STOVE
COOKING STOVE OTHER(Please Specify) IJ N O Gaa VN Q t N�
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):
Z CQ 2 11/l A YcA 1 Ye ` cc+r �
P r f 1_4,tc..�-��O to �q ZIP
p
9 DIGIT PARCEL ID NUMBER O Z( 3 02.7
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT j ;1 toe S ` Ul�c1 C lri� PHONE 2 (o - 7 --.7 9 'd
MAILING ADDRESS l °I,2 S-S rstc:c31,1
e CA 1 i - VP ZIP G6 l
PROPERTY OWNER i a\rt 2 'i ✓tip ac`'\ PHONE
MAILING ADDRESS S Jne
�..• ZIP
CONTRACTOR C ;fl4 Aegua. PHONE
MAILING ADDRESS 2.01( 4- SP-. 3oC
Pro,�...�.5►��►,� //���, ,,11W A `GO37o ZIP
STATE LICENSE# J�/F+�' 1"�44 QTS" PO 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 st ucture shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE ;% �6 DATE 6 / ��{ /G
FOR OFFICE USE ONLY �t
BASE FEE $48.00 RECEIPT# —Ct
CONSISTENCY REVIEW CASH/CK# "'o\61-1--
TOTAL -�T DATE Cp/ /
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