HomeMy WebLinkAboutBLD2004-00389 • 10
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 #: BLD04-00389 Received Date 6/15/2004
SITE ADDRESS: 20 PATHFINDER LN Issue Date 6/15/2004
PORT LUDLOW, 98365
APPLICANT: JOHN R MAKI PHONE:
CAROL L MAKI
20 PATHFINDER LN
PORT LUDLOW WA 983659629
SUBDIVISION: PORT LUDLOW NO 2 AREA 3 Block: Lot:
PARCEL NUMBER: 990603190 Section: 9 Township: 28N Range: 01 E
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2004
OWNER, JOHN R MAKI PHONE:
if different: CAROL L MAKI
20 PATHFINDER LN
PORT LUDLOW WA 983659629
PROJECT DESCRIPTION: INSTALL 100 GAL PROPANE TANK AND PIPE
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 6/15/2005.
REQUIRED INSPECTIONS:
[ ] Tank/Li /Appliancg (O Jd'�a1,
[ ] FinalApproval: /A0 Af
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
• BUILDING PERMIT APPLIION BLRD04 003389
w Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00389 Received Date: 6/15/2004
SITE ADDRESS: 20 PATHFINDER LN
PORT LUDLOW, 98365
OWNER: JOHN R MAKI PHONE:
CAROL L MAKI
20 PATHFINDER LN
PORT LUDLOW WA 983659629
SUBDIVISION: PORT LUDLOW NO 2 AREA 3 Block: Lot:
PARCEL NUMBER: 990603190 Section: 9 Township: 28 N Range: 01 E
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr iNSTALL 100 GAL PROPANE TANK AND PIPE
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: �y / egf77
F&W Landslide
t`�'�( C / Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 PRB 06/14/04 64534
Total: $48.00
JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNS D WA 98368 PH: (360)379-4450
R
litSTALLATION PERMIT APPLICATIO
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* Above Ground PROPANE TANK* SIZE OF PROPANE TANK /00 --
HEAT STOVE HOT WATER TANK WOODSTOVE X FIREPLACE INSERT • PELLET STOVE
COOKING STOVE , OTHER(Please Specify) 1 I Z° �Cip-e--/
Is this appliance(woodstcve,htg stove, hot water tank,furnace, etc.)to be installed in a Manufactured/Mobile
YES ....4. NO
SITE ADDRESS(911#/Road Name):
1 2__,C) 0-.)( 71-)-- (10,j---, (—('Z't '
0 ZIP e 9 S ,
C� n � / �
9 DIGIT PARCEL ID NUMBER 9 l v �j / /0
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT c46"11-v, A C.e P p L, PHONE e/3 7 o-eY/6
MAILING ADDRESS .i-
ZIP
PROPERTY OWNER C1 I J-�G ct `4 PHONE 611/J' z-4---
C :o
MAILING ADDRESS 90 L_C.G-1`1_14
ZIP �j
CONTRACTOR S Yl 5 N l h ._ PC O()2�f Est �J
. PHONE f 983 -�/ ( 7
MAILING ADDRESS I O e 533 1� P 1-10 aLi 0►r.
Por-11 t'dad L t0C.k, zip q e.33�]
STATE LICENSE# 34h- f-F P 7 7 Q /- EXP.DATE I 1/0
FEDERAL I.D.# 9 1 - ,i a 71 8 5'7
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./
/ /
APPLICANTS SIGNATURE Cti- )4) Li-rry,� Q--tc-\ DATE /I/ / / L
FOR FIDE ISE ONLY
BASE FEE I $48.00 I l I � ~-- RECEIPT# !�" � 4
CONSISTENCY REVIEW $24.00 I t 1 r. c,: C�
! J L: CASH/CK# ��
TOTAL DATE Vo►/ j O4—
*
Propane Tank applications require additional information to be submitted.
Please contact our office at 360-379-4450 if the back of this application is blank. OVER .. . •
G:\PermitCenter\FORMS\BLDG FORMS\install-revised 01-26-04.DOC
,I ;
I . • •
SITE VISIT REPORT it
(PLOT PLAN)
JOB DATE
:.., ''.
•
CONTACT:
ADDRESS •
PHONE #:
DIRECTIONS •
FAX ,•
Email
PLANNER: ,, ,,
,
--/-,-4, /G,(1 Ce-/4
,(/,(6.-- (-,r/r7",`fr''xr i,//771 147-/zoo7'? /,,,7
— •--- -
). 1,
I
s,,12.,
I 1 1
\ .
I'---,
-N I
N\ ,
1
\
t 1
re r let-4,rc. Sr IV/ / / / j
\P‘I/r75,,ric. 1
115') "651"- , L
--) - ---___ 1-1,-37/47)7/ £9')/.
r _ ?ot-cl, ct,- tee r. 71 A-44'C.
/lel7fee4 94 s't
-e----ec,kr /9//>1
--- - ‘0-------• '
- , v• •
_----;
\\I-7:\-\ ......,t ___---
‘ -,,
4. 4icAliTr it > /
r' Cr 104 -4k AX,V i-16-, 2., / ld
)
( C .-r's,,N'.2.-cA 4..4k(-1.ia) -,..-',rsis: ` (/'? L .k.IA‘L Vic,r71`7/M-C1 i 1)
J'-.7 i "JIAT
‘Al‘k r( "9/ Atl‘k
, .1. ,
ta; StWIA. 11-' C•-)S1'•eSea^, •
1-- -t- I OtalUi 'OESS bay 4 , •
9fee5 / ' ke-iei90 .