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HomeMy WebLinkAboutBLD2004-00580 • # 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 #: BLD04-00580 Received Date 9/13/2004 SITE ADDRESS: 640 CAPE GEORGE RD Issue Date 9/13/2004 PORT TOWNSEND, 98368 APPLICANT: JEFFREY S CHAPMAN PHONE: EILEEN CHAPMAN 640 CAPE GEORGE RD PORT TOWNSEND WA 983689241 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001173009 Section: 17 Township: 30N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2004 OWNER, JEFFREY S CHAPMAN PHONE: if different: EILEEN CHAPMAN 640 CAPE GEORGE RD PORT TOWNSEND WA 983689241 PROJECT DESCRIPTION: NO MLA REQ'D -A/G 120 GAL PROPANE TANK, HOT WATER HEATER 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 09/13/2005. REQUIRED INSPECTIONS: [ ] Tank/Line/Appliance: )_ [�,}� FinalApproval: c.� 7 9✓A 3- 0-41 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 10/29/19c •BUILDING PERMIT APPLICIION BLD04-00580 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD04-00580 Received Date: 9/13/2004 SITE ADDRESS: 640 CAPE GEORGE RD PORT TOWNSEND, 98368 OWNER: JEFFREY S CHAPMAN PHONE: EILEEN CHAPMAN 640 CAPE GEORGE RD PORT TOWNSEND WA 983689241 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001173009 Section: 17 Township: 30 N Range: 01 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 DESCRIPTIOP NO MLA REQ'D -A/G 120 GAL PROPANE TANK, HOT WATER HEATER 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: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: 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 09/13/04 67641 Total: $48.00 r - - JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST.PORT TOWNSEND WA 98368 PH: (360)379-4450 ALLATION PERMIT APPLICATIO. MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION - • 1 / Underground PROPANE TANK* Above Ground PROPANE TANK* SIZE OF PROPANE TANK a6--Q.. HEAT STOVE HqT WATER TANK WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE OTHER(Please Specify) j /9 Yl ---L.-C S S ( • Is this appliance(woods ove,htg stove, hot water tank,furnace,etc.)to be Installed In a Manufactured/Mobile i Home? " YES NO SITE ADDRESS(911#/Road ame): , 6 7`0 �e.-4„� p r - �� ZIP_ l � P 9 DIGIT PARCEL ID NUMBER 2 O ( t 7 3 cf) o / • Legal Description: Subdivision Name Block Lot(s) "'e' Section Township North, Range WM APPLICANT Vim-u - PHONE -?4B - , zj b MAILINGc� cr�• ADDRESS t_ • • �, j ZIP PROPERTY OWNER alryd-" ` a-' _ PHONE 6`1c ti"•--Z-o 1."'1 MAILING ADDRESS a L-C �- _j n >'i ZIP •: > CONTRACTOR S t-1-111 5 N 111 e Pr 0 p ars___ PHONE • MAILING ADDRESS 1 0 el S 3 R hod`1 0 r • n1 ©1^T I•ladI_ ock, 1;08 • ZIP ci0.3.3� ?y.,,t I' 3i-thS STATE LICENSE# FF h %�C D�] 7 � n EXP.DATE I ��0 FEDERAL I.D.# • 11 -( O798S`7 ;'' ' By signing the application form,the applicant/owner attests that the information provided herein is true and correct to the best of their knowledge. Any material falsehood or any omission of a material fact made by the applicant'owner with respect to this application packet inay result in this permit being null and void. ' I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and expenses which may in any way accrue against Jefferson County$s 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 entrYto the applicant's property or structure shall be requested and shall occur during regular business hours. APPLICANTS SIGNATURE CA-. ( 1r--,-0 .0-if-�. DATE Y / l / a`1 FOR OFFICE USE ONLY BASE FEE 1 $48.00 RECEIPT# C CONSISTENCY REVIEW $24.00 CASH/CK# 4�3 1 I TOTAL • - - DATE. G t 1 1 J * ! .041 1 �. Propane Tank applications require additional information to be li , tfe�:Please contact our office at 360T379.4450 if the back of this applic i�rt Is blank. OVER -, . . L SEP 1 3 2004 1,,ti 1 $ i i JEr FE h6LN LCUNTY 1 OEPT. OF COi.i1,iuNl1Y DEVELOPMENT 1 G:\PermitCenter\FORMS\BLDG FORMS\install-revised 01-26-04.DbC — SITE VISIT REPORT (PLOT PLAN) JOB -2- C. .(0 l a li•v DATE : /tc-i/ `l . CONTACT: ADDRESS PHONE #: _ DIRECTIONS FAX #: Er.-mil L;/4{%,:,t, t,olylies.uc74 , PLANER: /P1 (mitt- rugi, ,)ay,1's G ., c (� 61&) 7D1,4r c � 4\ ((c( .z-FA- a«eiO2 I&5i 6 c,.15--lei--41 , 2 r— 1 . . -� - i , e liC Di- Qc 1 01,70.0, I l„ 1 'O v), jp ,61)))) i\ © 0 10 1 - ,\p„, \ • _ , ,, _ _ 11) r`±' ( ' -- ' 1 411 rb Y_I'' ' _ - 1 \1 r SEP 1 3 1 IL "PT.OF CO, ..1 : L,tvE Q t.;_