HomeMy WebLinkAboutBLD2004-00492 0 0
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 #: BLD04-00492 Received Date 7/24/2004
SITE ADDRESS: 101 MAPLE DR Issue Date 7/24/2004
PORT TOWNSEND, 98368
APPLICANT: CYNTHIA L WILSON PHONE: (360)765-0303
101 MAPLE DR
PORT TOWNSEND, WA 98368
26
SUBDIVISION: CAPE GEORGE VILLAGE DIV 4 Block: Lot:
PARCEL NUMBER: 940800026 Section: 13 Township: 30N Range: 02W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2004
OWNER, CYNTHIA L WILSON PHONE: (360)765-0303
if different: 101 MAPLE DR
PORT TOWNSEND, WA 98368
PROJECT DESCRIPTION: INSTALLATION OF 120 GAL ABOVE GROUND PROPANE TANK,
HEAT STOVE
COOKING STOVE AND GAS 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 7/24/2005.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:'�/4r5K/L/N'///eG#y 57-2,o ie.,A/y
[ ] FinalApprovaL(� '( / O
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 APPLIATION BLD04-00492
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00492 Received Date: 7/24/2004
SITE ADDRESS: 101 MAPLE DR
PORT TOWNSEND, 98368
OWNER: CYNTHIA L WILSON PHONE: (360)765-0303
101 MAPLE DR
PORT TOWNSEND, WA 98368
SUBDIVISION: CAPE GEORGE VILLAGE DIV 4 Block: Lot: 26
PARCEL NUMBER: 940800026 Section: 13 Township: 30 N Range: 02 W
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 INSTALLATION OF 120 GAL ABOVE GROUND PROPANE TANK,
HEAT STOVE
COOKING STOVE AND GAS PIPE
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 PRB 07/23/04 66496
Total: $48.00
M IEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST PORT TOW ND WA 98368 PH: (360)379-4450
STALLATION PERMIT APPLICATI
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* X Above Ground PROPANE TANK* SIZE OF PROPANE TANK I 2-0
(u HEAT STOVE HOT WATER TANK WOODSTOVE FIREPLACE INSERT • PELLET STOVE
x COOKING STOVE OTHER(Please Specify) frko
P uv,-Q...,
Is this appliance(woodstove, htg stove, hot water tank,furnace,etc.)to be installed in a Man
Home?
•1• 14.V ,
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YES N NO "�'
SITE ADDRESS(911#/Road Name):
10 YY) -e - Or . JUL t 21004
Pr T ZIP Gd')6d'
9 DIGIT PARCEL ID NUMBER 1 0 Sao 0 Z-(o JC�'FEASON COtMITY DCp
Legal Description:
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Subdivision Name Block Lot(s)
Section Township North, Range WM
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APPLICANT �✓�`r 1 L� ��J t(�Ujt, PHONE ! 6s -03 0 3
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MAILING ADDRESS 1 0 ( u ►r t VJ r
P'Y`i- T0 L ytil..e„,Q C.)c- ZIP
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PROPERTY OWNER 6�t� J-�L LC cLa PHONE —C 4-.-Z.,::;,
MAILING ADDRESS �-!" f",,'�L c G—,----_La
ZIP
CONTRACTOR S LA-11 5 I-I I h (:.-1- P1 CU r)c(,f-`-- PHONE 3 •F S 7 ( 7
MAILING ADDRESS r [1 0b��3 k� uc{Li I)r . �7
Per- 1Yad� L.. L'}C.k, 1,\J6 • ZIP ci 03.3
STATE LICENSE# 3�01--C f-F P r 0-7 7 Q h EXP.DATE I 1,O `f
FEDERAL I.D.# -! ( ' f O 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 CA, 14-,-,-y7 Q---v--\____ DATE ? I . .I / 0
FOR OFFICE USE ONLY
BASE FEE $48.00 RECEIPT#
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CONSISTENCY REVIEW $24.001:4 V. ''o`' CASH/CK
TOTAL j 77 CV DATE i r `;
*
Propane Tank applications require additional information to be submitted. ;r' ;*
Please contact our office at 360-379-4450 if the back of this application is blank. a ., V Y E R
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