HomeMy WebLinkAboutBLD2004-00450 0
BUILDING PERMIT APPLICOION BL 450
Revviewiew T Tyype:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00450 Received Date: 7/1/2004
SITE ADDRESS: 60 CONDON LN
PORT LUDLOW, 98365
OWNER: STANLEY L KRUGMAN PHONE:
GAIL H KRUGMAN
PO BOX 6173
CARMEL CA 939216173
SUBDIVISION: PORT LUDLOW NO 1 AREA 2 Block: Lot:
PARCEL NUMBER: 990400213 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 DESCRIPTIOt NO MLA REQ'D - ABOVE GROUND 120 GAL PROPANE TANK, HEAT
STOVE
& PIPING
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: F&W Landslide
Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 CJZ 07/01/04 66430
Total: $48.00
1110 •
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 #: BLD04-00450 Received Date 7/1/2004
SITE ADDRESS: 60 CONDON LN Issue Date 7/1/2004
PORT LUDLOW, 98365
APPLICANT: STANLEY L KRUGMAN PHONE:
GAIL H KRUGMAN
PO BOX 6173
CARMEL CA 939216173
SUBDIVISION: PORT LUDLOW NO 1 AREA 2 Block: Lot:
PARCEL NUMBER: 990400213 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, STANLEY L KRUGMAN PHONE:
if different: GAIL H KRUGMAN
PO BOX 6173
CARMEL CA 939216173
PROJECT DESCRIPTION: NO MLA REQ'D -ABOVE GROUND 120 GAL PROPANE TANK,
HEAT STOVE
& PIPING
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 07/01/2005.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: Vl//iC a.* : a/
FinalApproval: odico4C, -7,43JO`7
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 10/29/19E
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JEFFERSON COUNTY COMMUNIT' VELOPMENT,621 SHERIDAN ST.PORT TOWNS •WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APP
LICATIO
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
,
Underground PROPANE TANK* Above Ground PROPANE TANK* SIZE OF PROPANE TANK ( Z t3 G-A •
X HEAT STOVE HOT WATER TANK WOODSTOVE FIREPLACE INSERT • PELLET STOVE
COOKING STOVE OTHER(Please Specify) ( -0 J ,- -C,
Is this appliance(woodstbve, htg stove, hot water tank,furnace,etc.)to be installed in a Manufactured/Mobile
Home?
YES NO
SITE ADDRESS(911#/Road Name):
6L L/-v
P 1 ZIP (ji e."� s
9 DIGIT PARCEL ID NUMBER 4, C9 76 IlD 0 a / 3 .
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT (-t I C / f2-,9,-,-,., a_,____. PHONE `T-7 7 7 f c 2-
MAILING ADDRESS S
ZIP
PROPERTY OWNER-- C aL 4 PHONE U 1 C 4-4-ZO
MAILING ADDRESS c i---c 1,,-ti`.L4
ZIP
CONTRACTOR S LA-Y) S N 11i '- Pr i`() aA-‘.12,_ PHONE
MAILING ADDRESS I Ob?�13� I�0c{i Ir.
Por` -T hladLbckt IA)ri . ZIP C10�7
.33
STATE LICENSE# 3 thS(-E19 >CD-7 7 Q A EXP.DATE 11/0 `f
FEDERAL I.D.# q 1 - i 0 7'I 8 S'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 CA - 14-,-,-- 0 a--1'Th____ DATE .2 / / / C7`f
FOR OFFICE USE ONLY ;:, , f s
BASE FEE }`
$48.00 RECEIPT# $ t k "`
v
CONSISTENCY REVIEW ( ( — 1
$24.00 D) [ C t'_ P '�'t E CASH/CK# - � .'
TOTAL I DATE l t(
! v ��7 pp'pp�}�r�
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Propane Tank applications require additional inform tbn to be st]b?i ted. ' 'OVER Please contact our office at 360-379-4450 if the back of This application is blank.
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„cPT. OF CO', i l'Y (DEVELOPMENT
G:\PermitCenter\FORMS\BLDG FORMS\install-revised 01-26-04.DOC