HomeMy WebLinkAboutBLD2004-00411 OUILDING PERMIT APPLICA N BLD04-00411Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00411 Received Date: 6/22/2004
SITE ADDRESS: 74 BEATTIE AVE
PORT TOWNSEND, 98368
OWNER: VIRGINIA MCINTYRE PHONE: 360-385-3526
P 0 BOX 708
CHIMACUM WA 98325
SUBDIVISION: IRONDALE Block: 103 Lot: 29-34
PARCEL NUMBER: 962110310 Section: 34 Township: 30 N Range: 01 W
CONTRACTOR: C H S PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CHSIN**9790Z Expires 09/06/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION 250 GAL ABOVE GROUND PROPANE TANK AND LINE
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
Total:
i •
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 #: BLD04-00411 Received Date 6/22/2004
SITE ADDRESS: 74 BEATTIE AVE Issue Date 6/22/2004
PORT TOWNSEND, 98368
APPLICANT: VIRGINIA MCINTYRE PHONE: 360-385-3526
P 0 BOX 708
CHIMACUM WA 98325
29-34
SUBDIVISION: IRONDALE Block: 103 Lot:
PARCEL NUMBER: 962110310 Section: 34 Township: 30N Range: 01W
CONTRACTOR: C H S PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CHSIN**9790Z Expires 09/06/2004
OWNER, VIRGINIA MCINTYRE PHONE: 360-385-3526
if different: P 0 BOX 708
CHIMACUM WA 98325
PROJECT DESCRIPTION: 250 GAL ABOVE GROUND PROPANE TANK AND 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 06/22/2005.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: i' rrc Pis ; c.1/G i-'r'C(str<jc,7'Zi-cor
[ ] FinalApproval: C. �/7 O t
)„,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
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JEFFERSON COUNTY COMMUNIVELOPMENT,621 SHERIDAN ST,PORT TOWN.WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION , ZJ
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* Above Ground PROPANE TANK* SIZE OF PROPANE TANK Z5o
HEAT STOVE 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?
YES NO
SITE ADDRESS(911#/Road Name):
`7 y g- rr ,4 V- -
1 1JyGe.1.yc)/ ZIP q0✓t=�
9 DIGIT PARCEL ID NUMBER q Z— /( 0 3/a
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT
LK�V ((��S-1(N t `-., P.CIN1V(fZ' PHONE 3s 5.-- 3S2 6
MAILING ADDRESS Po U 0 /02,
cAtv ekitAciAM ZIPqs-3 Z c
PROPERTY OWNER SAttie- — PHONE
MAILING ADDRESS
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C_
CONTRACTOR , s PHONE
MAILING ADDRESS
ZIP
STATE LICENSE# G N El L-e-- 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 appli is prop rty or structure shall b requested and shall occur during regular business hours.
APPLICANTS SIGNATURE (.-. 24 DATE / `--Z. /
_a_y____
FOR OFFICE USE ONLY
BASE FEE $48.00 RECEIPT#
CONSISTENCY REVIEW $24.00 CASH/CK#
TOTAL 7c r 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