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HomeMy WebLinkAboutBLD2004-00493 a 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 #: BLD04-00493 Received Date 7/24/2004 SITE ADDRESS: 81 MC CURDY LN Issue Date 7/24/2004 PORT LUDLOW, 98365 APPLICANT: CONSTANCE MAC DONALD PHONE: 81 MCCURDY LN PORT LUDLOW WA 983659612 156 SUBDIVISION: PORT LUDLOW NO 2 AREA 3 Block: Lot: PARCEL NUMBER: 990603156 Section: 9 Township: 28N Range: 01E CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2004 OWNER, CONSTANCE MAC DONALD PHONE: if different: 81 MCCURDY LN PORT LUDLOW WA 983659612 PROJECT DESCRIPTION: RELOCATE EXISTING TANK , HEAT 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: -63 7 [ ] FinalApproval: // /_7 -©-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 I:\F_BLD_Permit_propane.rpt 10/29/19 BUILDING PERMIT APPLIATION BLD04-00493 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD04-00493 Received Date: 7/24/2004 SITE ADDRESS: 81 MC CURDY LN PORT LUDLOW, 98365 OWNER: CONSTANCE MAC DONALD PHONE: 81 MCCURDY LN PORT LUDLOW WA 983659612 SUBDIVISION: PORT LUDLOW NO 2 AREA 3 Block: Lot: 156 PARCEL NUMBER: 990603156 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 DESCRIPTIOI RELOCATE EXISTING TANK , HEAT 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 �{ : O� Shoreline Aquifer Forest: Commercial Rural Type Amount Paid Bv: Date: Receipt: Approved/Date Propane Tanks/Stoves $48.00 PRB 07/23/04 66495 Total: $48.00 1 c<a 2.41 )EFFERSON COUNTY COMUITY DEVELOPMENT,621 SHERIDAN ST,PORT TO SEND WA 98368 PH: (360)379-4450 1 IF INSTALLATION PERMIT APPLICA N MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION Underground PROPANE STANK* Above Ground PROPANE TANK* SIZE OF PROPANE TANK o (HEAT STOVE H T WATER TANK WOODSTOVE FIREPLACE INSERT PELLET STOVE `COOKING STOVE I OTHER(Please Speafy) P t✓2 T7,..,-..._ �_.r. tr `� =�w NS'u:!IL�7GZe`f!& %IL.`! Is this appliance(wgodsiove,htg stove, hot water tan ,furnace,etc.)to be installed in a Ma ure�i. co! 0 a"bli, ��" ' YES . NO SITE ADDRESS(911#/Road Name): . gL m e C.r, .ZIP J fCR ii J'� 6 SON COUNTY.DCD c 0 ` 9 DIGIT PARCEL ID NUMBER / J 6 b3 / 6 Legal Description: } k Subdivision Name Block Lot(s) Section Township North, Range WM APPLICANT S 5-1>,_t LS PHONE L.,i a.1_35 MAILING ADDRESS I.3 / &� ,.-' '', ''?!7 .. 4.4,...k.f zo„) PROPERTY OWNER 2 14-6-`c a_4 PHONE (9 C a MAILING ADDRESS C -c 1.-,.�..,C4 i ZIP CONTRACTOR S L- h 5 N I Yq 'L PC O p(1,f-� �7, PHONE 3 O s --S 7 !G 7 MAILING ADDRESS I O ;J? R I'10 a I)r'. Por* 4aci L. rick, I)il • ZIP 03.3 tY` 1- H p C 07 A I e� STATE LICENSE# � / 7 Q EXP.DATE � 0 ( ':'t. FEDERAL I.D. o Ti.# ' !) !� S'1 . x By signing the application form,the abplicanUowner 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 py 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 ,1 way accrue against Jefferson County as a result of or in consequence of the granting of this permit. A 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. :'r APPLICANTS SIGNATURE Cti ti , >�� Ott DATE 7 I a! / a . FOR OFFICE USE ONLY BASE FEE I RECEIPT# �f�t l $48.00 Cl k I O�') CONSISTENCY REVIEW $24.00 CASH/CK# ( )-( f TOTAL 2! 1 '�"'� � DATE / / * Propane Tank applications require additional information to be submitted. (��� . Please contact our office at 360 i379-4450 if the back of this application Is blank. i 1 G:\PermitCenter\FORMS\BLDG FORMS\install-revised 01-26-04.DOC I SITE VISIT REPORTS (PLOT PLAN) JOB DATE : CONTACT: ADDRESS PHONE #: DIRECTIONS FAX #: Email PLANNER: Y\ /5" '.)( - 7-Ao r(Vr Vafit e 5(ier476r,htt< • 7-Th /0 1 S _ *4' 79377z f.-A5e viewt v, • ttitiA0-lia I.:40 Ati 2 2014 JEFFERSON COUNTY DCD rx2e-(977 . fr Z.1' 2retegc„..- • Aeie /.2-6 &I'"4- • /2 c':5 2-"" • • • •