HomeMy WebLinkAboutBLD2004-00543 • . ,
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 #: BLD04-00543 Received Date 8/26/2004
SITE ADDRESS: 1325 OLD GARDINER RD Issue Date 8/27/2004
SEQUIM, 98382
APPLICANT: MORGAN K VAN DYKE PHONE: (360) 797-0066
ELIZABETH A VAN DYKE
1325 OLD GARDINER RD
SEQUIM WA 98382 1
SUBDIVISION: ROLLINS SHORT PLAT Block: Lot:
PARCEL NUMBER: 002342055 Section: 34 Township: 30N Range: 02W
CONTRACTOR: EVERWARM INC PHONE: (360)452-3366
257151 HWY 101
PORT ANGELES WA 98362
Contractor's License EVERWI*088NL Expires 8/17/2006
OWNER, MORGAN K VAN DYKE PHONE: (360) 797-0066
if different: ELIZABETH A VAN DYKE
1325 OLD GARDINER RD
SEQUIM WA 98382
PROJECT DESCRIPTION: PROPANE FIREPLACE & GAS PIPING -EXISTING PROPANE TANK
-NO MLA REQ'D
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 8/27/2005.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: ,2bei Z0 Ci f- /6— D 6(
[ ] FinalApproval: ann1aw
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 APPLI•TION BRD00 00eview p 93
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD04-00543 Received Date: 8/26/2004
SITE ADDRESS: 1325 OLD GARDINER RD
SEQUIM, 98382
OWNER: MORGAN K VAN DYKE PHONE: (360) 797-0066
ELIZABETH A VAN DYKE
1325 OLD GARDINER RD
SEQUIM WA 98382
SUBDIVISION: ROLLINS SHORT PLAT Block: Lot: 1
PARCEL NUMBER: 002342055 Section: 34 Township: 30 N Range: 02 W
CONTRACTOR: EVERWARM INC PHONE: (360)452-3366
257151 HWY 101
PORT ANGELES WA 98362
Contractor's License EVERWI*088NL Expires 8/17/2006
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI PROPANE FIREPLACE & GAS PIPING - EXISTING PROPANE TANK
-NO MLA REQ'D
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 2003 HEAT BASE: HEAT TYPE:
OCCUPANCY:
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 KAS 08/26/04 67531
Total: $48.00
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JEFFERSON COUNTY COMMUNITY DEVELOPMENT,62L SHERIDAN ST, PORT TOWNSEND WA 98368 PH: (360)379-1450
. 3<-. i .--1--i ' INSTALLATION PERMIT APPLICATION _
WOODSTOVE PROPANE TANK PELLET STOVE OTHER -'ro p4 r►.Q� 1'7 rep Jo-CA— 1CLSQ i F;, q
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Is this appliance(htg stove, hot water tank,furnace, etc.)to be installed in a Manufactured/Mobile Home?
YES ✓O
SITE ADDRESS(911 #/Road Name):
13 a.5 OC.n G A2ni n/t12 Q.C2E,
S5. tM L/ - ita,,/N£.y .,/ t11/)ZIP 1() 39 DIGIT PARCEL ID NUMBERto
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Legal Description: p �}
Subdivision Name 1\b , /►NS S yh h r PL I/" Block Lot(s)
Section Township North, Range WM
APPLICANT M0k 64t1 A/ VAAJ We- PHONE .3 (d ?9 2 _(),6,,
MAILING ADDRESS /3 0. .t_d 4.0 6 412- /� /.t/f/2 ,'
,S T.cp u l/n/ kA ZIP PS.3 _
PROPERTY OWNER f OR4Ard y- f G/z4 R / VAti k PHONE 3 6_O 7_7 0'a%
MAILING ADDRESS
/3 oZ-S 6 1-.Lb Gee�o/,�� e� --
.‹ v��1 447A ZIP V.• 8OZ-
CONTRACTOR c ,V E, ? �/z lle) _ PHONE 0_�` Z 364,
MAILING ADDRESS . 5 7/,S:/ - ' Y 1 a / _
-Pow --1, At---ne.\e_S� 6c� - - ZIP ()'3 to 2
STATE LICENSE# \AD 1 C2 Cr q KI L EXP,DATE 15. 1 II l O.S.—
FEDERAL I,D.# q 1 -- I5`T 07cq
By signing the application form, the applicant/owner etteats 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 vo,d.
I further agree to save, indemnify and hold harmless Jefferson County against all liabilities,judgments, court costs, reaeonable 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.
l 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 end right of entry to the applicant's property or, cture shall be requested and shall occur during regular business hours.
APPLICANT SIGNATURE e�y / /� �6 Q���_ C DATE...... / . I
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l�� FOR OFFICE USE ONLY
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