HomeMy WebLinkAboutBLD2004-00408 UILDING PERMIT APPLICA BLD04-00408
N Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00408 Received Date: 6/22/2004
SITE ADDRESS: 71 CAMANO LN
PORT LUDLOW, 98365
OWNER: HARVEY R HEGSTROM PHONE: 360-265-0234
71 CAMANO LANE
PORT LUDLOW WA 98365
SUBDIVISION: PORT LUDLOW NO 2 AREA 2 Block: 2 Lot: 45
PARCEL NUMBER: 990600245 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 PIPING AND HEATER
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:
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 06/22/04 66384
Total: $48.00
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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 #: BLD04-00408 Received Date 6/22/2004
SITE ADDRESS: 71 CAMANO LN Issue Date 6/22/2004
PORT LUDLOW, 98365
APPLICANT: HARVEY R HEGSTROM PHONE: 360-265-0234
71 CAMANO LANE
PORT LUDLOW WA 98365
45
SUBDIVISION: PORT LUDLOW NO 2 AREA 2 Block: 2 Lot:
PARCEL NUMBER: 990600245 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, HARVEY R HEGSTROM PHONE: 360-265-0234
if different: 71 CAMANO LANE
PORT LUDLOW WA 98365
PROJECT DESCRIPTION: PIPING AND HEATER
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 06/22/2005.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: r /47:
[ FinalApproval:
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 COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNSEINWA 98368 PH: (360)379-4450
INOALLATION PERMITAPPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION / ' ` n
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Underground PROPANE TANK* Above Ground PROPANE TANK* SIZE OF PROPANE TANK
HEAT STOVE HO1I WATER TANK WOODSTOVE FIREPLACE INSERT PELLET STOVE
COOKING STOVE OTHER(Please Specify) (90 i C'/Z,,v ej--e
Is this appliance(woodst4ve,htg stove, hot water tank,furnace,etc.)to be installed in a Manufactured/Mobile
Home?
I YES k NO
SITE ADDRESS(911#/Road Name):
( ( / - 1yJG CAi .
(��c�, 1i1.L - c�1 ✓ ZIP !7�J .. _S
9 DIGIT PARCEL ID NUMBER 9 ! 6 & G o c,1 ` 16
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT 71'1r-7-r-0)-,—, PHONE )C G -� Lf C"23
MAILING ADDRESS 7/ C1 --z 6-,--.� /L >
;T �,� r cJ ZIP 9t G,J—
PROPERTY OWNER C c4 PHONE - ;-4---C'-.,
MAILING ADDRESS t2,44-c_i--►- 4
ZIP 7
CONTRACTOR S LA-Y) S 1-4I)n L Pr G P a_r,�_ PHONE rS 5 -�7 /
MAILING ADDRESS ( obo i3 Pckod.c..., 0r. �7
Pori- flad k 6c k, 1,N)0 • ZIP q 8.3.3
STATE LICENSE# S(- h-S H-P -7 7 ( A EXP.DATE i (/0 'f
FEDERAL I.D.# C7 ( ` / 079' 85'1
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 g 1-1,- 7 L -1C1_ DATE 6 / 2--2—r-G
'", FOR OFFICE USE ONLY
RECEIPT r� � e � , $48.00 s 0 ,
SIO i' :- ,
CASH/CK# > 8� ,,
h s 1 03
* ` DATE ;:, ,i ,0 .,
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 . I+
G:\PermitCenter\FORMS\BLDG FORMS\install-revised 01-26-04.DOC
SITE VISIT REPORT
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