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HomeMy WebLinkAboutBLD200400552 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 #: BLD04-00552 Received Date 8/31/2004 SITE ADDRESS: 526 THUNDER RD Issue Date 8/31/2004 PORT TOWNSEND, 98368 APPLICANT: AMANDA M KINGSLEY PHONE: MICHAEL L KINGSLEY 526 THUNDER RD PORT TOWNSEND WA 983689456 7 SUBDIVISION: MARIAH HEIGHTS Block: Lot: PARCEL NUMBER: 002125007 Section: 12 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, AMANDA M KINGSLEY PHONE: if different: MICHAEL L KINGSLEY 526 THUNDER RD PORT TOWNSEND WA 983689456 PROJECT DESCRIPTION: PROPANE LINE EXTENSION 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 8/31/2005. REQUIRED INSPECTIONS: [ ] Tank/Line/Appliance: f// , [ ] FinalApproval: (A/ rid 91.9/1/4 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 BUILDING PERMIT APPLIi Review T TyION BL y552 pe: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD04-00552 Received Date: 8/31/2004 SITE ADDRESS: 526 THUNDER RD PORT TOWNSEND, 98368 OWNER: AMANDA M KINGSLEY PHONE: MICHAEL L KINGSLEY 526 THUNDER RD PORT TOWNSEND WA 983689456 SUBDIVISION: MARIAH HEIGHTS Block: Lot: 7 PARCEL NUMBER: 002125007 Section: 12 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 DESCRIPTIOD PROPANE LINE EXTENSION TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP ALT 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 08/30/04 66746 Total: $48.00 ' , JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNSEND.WA 98368 PH: (360)379-4460 r OSTALLATION PERMIT APPLICAT MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION _ ' Underground PROPANE 1rANK* Above Ground PROPANE TANK* SIZE OF PROPANE TANK HEAT STOVE HQT W TER TANK WOODSTOVE Fl PLACE INSERT PELLET STOVE COOKING STOVE OTHER(Please Specify) �`-a.) f 0 / G Is this appliance(wood f ve htg stove, hot water tank,furnace,etc.)to be installed In a Manufactu64/.(0bii.e Home? • YES NO SITE ADDRESS(911#/Road Name): t p°�" how.. kci ZIP � g3�g 9 DIGIT PARCEL ID NUMBER 0 0- 0-5 o© 7 • I Legal Description: Subdivision Name Block Lot(s) Section Township North,. Range WM � Q APPLICANT ` l (c--4--d--4J (/( !PHONE 3 / - 7/ 9/ MAILING ADDRESS :S/ 7—6 ZIP PROPERTY OWNER A-a-i� a_4 ' PHONE c c<-`-zo MAILING ADDRESS C-- L-C 4-r.._.�4 ZIP Q `V -S /7 CONTRACTOR S t�tit 5 N I ..)1 Pr O rJ c�-r\ PHONE 3 U f.7 MAILING ADDRESS I G e 3 P hod 1 r• Pori-(- 14ad L tick, 6\Jri • ZIP q e3.3�j STATE LICENSE# 3L-t I S(-F P C o.-7 7 Q A EXP.DATE I I/0 `t FEDERAL I.D.# q I - 10 7 q 83'7 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 nu!!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 agent>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 C CA-. p� � ! -�. DATE (-:)/ -7/ / / a,I • • f FOR OFFICE USE ONLY BASE FEE $48.00 RECEIPT# 6 6 ms:'. CONSISTENCY REVIEW CASH/CK# ''.. 3©3d .00 -- --- 22 �» TOTAL t A � �/7�-�'�� tJ / 4" Propane Tank applications require additional information to be Please contact our office at 360379-4450 if the back of this appli I blank. pm 4 (; 2004 0 4 4 4 JEFFERSON COUNTY G:\PermitCenter\FORMS\BLDG FORMS\install-revised 01-26-04.D0 DEPT.OF COMMUNITY DE�tELOPh1ENT ;y.;< SITE VISIT REPORT • i (PLOT PLAN) _ ► ;1 I' E JOB /7l/.//(/‘&/..")/ / /( :DATE /zI f 1 CONTACT: I ADDRESS PHONE #: DIRECTIONS r 'a f Email ,,- . PLANER: . `.4t A ! y,c Y — y,�,N I :t4'':::'; i ' f 1 ► 1 fdeksiov\ , i , ----------\N \. i J 1 l i I i EX Lsf to ti v► ,1-c c SonECE AV AU 0 2004 N DEd k04„, EPTOFc 5 i m i