HomeMy WebLinkAboutBLD2004-00467 lo • -
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 #: BLD04-00467 Received Date 7/13/2004
SITE ADDRESS: 50 ADVENTURER LN Issue Date 7/13/2004
PORT LUDLOW, 98365
APPLICANT: TERRY J SUTTON PHONE:
JANE A SUTTON
12045 CHEVIOT DR
HERNDON VA 201702704 218
SUBDIVISION: PORT LUDLOW NO 2 AREA 3 Block: Lot:
PARCEL NUMBER: 990603218 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, TERRY J SUTTON PHONE:
if different: JANE A SUTTON
12045 CHEVIOT DR
HERNDON VA 201702704
PROJECT DESCRIPTION: NO MLA REQUIRED-GAS 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 07/13/2005.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: rfor e 4 /E.er 3"-rovevk A 0,
[ ] FinalApproval: .olk c0r eA 7/ , „4/
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.
• BLD04-00467
BUILDING PERMIT APPLICOION Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00467 Received Date: 7/13/2004
SITE ADDRESS: 50 ADVENTURER LN
PORT LUDLOW, 98365
OWNER: TERRY J SUTTON PHONE:
JANE A SUTTON
12045 CHEVIOT DR
HERNDON VA 201702704
SUBDIVISION: PORT LUDLOW NO 2 AREA 3 Block: Lot: 218
PARCEL NUMBER: 990603218 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 DESCRIPTIOP NO MLA REQUIRED - GAS STOVE & PIPING
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW
VALUATION MAIN:
CODE EDITION: 2003 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 07/13/04 66603
Total: $48.00
r JEFFERSON COUNTY COMMUNIT EVELOPMENT,621 SHERIDAN ST,PORT TOWNSE WA 98368 PH: (360)379-4450
' TALLATION PERMIT APPLIC
ATIO
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION i
�1 A ClG4�e u 7 l S///1 pt
Underground PROPANE TANK* Above Ground PROPANE TANK* SIZE OF PROPANE TANK l
ccn
y HEAT STOVE HOT WATER TANK WOODSTOVE FIREPLACE INSERT r•.-. --svi
- —
COOKING STOVE OTHER(Please Specify) Gc.,
Is this appliance(woodst4ve, htg stove, hot water tank,furnace,etc.) to be installed nli Manu M b
ur?c ll
MQme? - JUL ‘I
YES _ X NO
SITE ADDRESS(911#/Road Name):
_ ::C,.� t.�i.U��7Y
050 466e-/ Je K�� (../ L_DEPT. OF CU;,,'.tv!�iiY DEVELOPMENT
l - L,,LK- ') W(- ZIP / �
9 DIGIT PARCEL ID NUMBER (% G 663 -2_,'2 f''
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANTf E ��`7 6. /5
PHONE
MAILING ADDRESS Q,
,' ZIP
PROPERTY ( 1 OWNER C�� -"-C. a'' PHONE --c a,,,-r--:;
MAILING ADDRESS 14 t_-c. t`4
ZIP
CONTRACTOR S t l h S N 111 e Pr O i c"14-,..Q___ PHONE
MAILING ADDRESS If3 e S3 1,10 d Or .
P 'r 1 f"ladLOCk, 1,‘J6 • ZIP ge.33
STATE LICENSE# SLt)1 S H P X D•7 / Q A EXP.DATE I I/O `f
FEDERAL I.D.# q l - / 0 71' 8.5''7
By signing the application form,the applicantlowner 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 t6 the applicant's property or structure shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE CA- 11-r.-77 Q-U-1 7 DATE / 9 / d
FOR OFFICE USE ONLY /_
BASE FEE /$48.00 RECEIPT# - 0
.3 '
CONSISTENCY REVIEW ..-$ 4 -^ CASH/CK# C .V)C��
•
TOTAL i,ei.g DATE / /L/4.
*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.
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1 SITE VISIT REPORT •
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