HomeMy WebLinkAboutBLD2004-00613 4
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 #: BLD04-00613 Received Date 9/28/2004
SITE ADDRESS: 281 FISH HATCHERY RD Issue Date 9/28/2004
QUILCENE, 98376
APPLICANT: UNITED STATES OF AMERICA PHONE:
US FISH &WILDLIFE
500 NE MULTNOMAH ST
PORTLAND OR 972322023
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 702224013 Section: 22 Township: 27N 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, UNITED STATES OF AMERICA PHONE:
if different: US FISH &WILDLIFE
500 NE MULTNOMAH ST
PORTLAND OR 972322023
PROJECT DESCRIPTION:
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 9/28/2005.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:_ -
[ ] FinalApprovaltIC
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
•B Review
UILDING PERMIT APPLICIION B 0613
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00613 Received Date: 9/28/2004
SITE ADDRESS: 281 FISH HATCHERY RD
QUILCENE, 98376
OWNER: UNITED STATES OF AMERICA PHONE:
US FISH &WILDLIFE
500 NE MULTNOMAH ST
PORTLAND OR 972322023
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 702224013 Section: 22 Township: 27 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 DESCRIPTIOI
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:
GARAGE: SHORELINE:
CONST TYPE: 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 09/27/04 67756
Total: $48.00
JEFFERSON COUN;rY COMMUNITY DEVELOPMENT,621 SHERIDAN ST.PORT TOWNS D WA 98368 PH: (360)379-4450
J • •TALLATION PERMIT APPLICATIOO
MARK ALL ITEMS BELOW THq,T PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* V Above Ground PROPANE TANK* SIZE OF PROPANE TANK 5 0 v
HEAT STOVE HOT WATER TANK WOODSTOVE FIREPLACE INSERT PELLET STOVE
COOKING STOVE X OTHER(Please Specify)
Is this appliance(woodsove, htg stove, hot water tank,furnace,etc.)to be installed in a Manufactured/Moblle
Hpme?
YES NO ....
SITE ADDRESS(911#/Road Name): `_ '� . • t++,
�( ZIP
r
9 DIGIT PARCEL ID NUMBER / U j -2 ` - ( Cj/ _3
1 Yr
Legal Description: ;i i I. i.i :,i
Subdivision Name Block Lot(s) _
.
Srtion Township _North, Range WM
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APPLICANT Q - _ g .` .., ",
c—� ��" "`� PHONE 7lv S - -3� 3 �/
MAILING ADDRESS - /
ZIP
PROPERTY OWNER a- Q.�C 2. PHONE _ �7-
f GL7 "-wC c
MAILING ADDRESS a- .-c_ 6--,`.1_'4
ZIP
CONTRACTOR S Yl S N I V) e Pr G p a,r� PHONE
MAILING ADDRESS -
1 O el S�3f (�h o�{L,� (r,
Per - .1 cl l C1c.k, t,k)il • ZIP CI E.3.3
STATE LICENSE# 34 VI'S(-}P (p`7 7 Q A /
EXP.DATE i 0 j`
FEDERAL I.D.# -1 I - / 0 7'I 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 tpy the applicant/owner with respect to this application packet may result in this permit being null and void.
I further agree to save,indemnify andjl hold harmless Jefferson County against all liabilities,judgments,court costs reasonable attomey'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 fight of entry to Jefferson County and it's employees,representatives or agents for the purpose of application review an
Inspections. Access and right of entryto the applicant's property or structure shall be requested and shall occur during regular business hours. d any required later
APPLICANTS SIGNATURE { CL ( t r-,-,7 .0-I-T DATE / • `// CJ•
`f
j FOR OFFICE USE ONLY
BASE FEE $48.00 RECEIPT# C77517
I
CONSISTENCY REVIEW $24.00 CASH/CK# 33
TOTAL j 12•G6
DATE _l a ! 7/ 0
Propane Tank applications require additional information to be submitted.
•
Please contact our office at 360+379-4450 if the back of this application is blank. OVER a* . -"
G:\PermitCenter\FORMS\BLDG FORMS\install-revised 01-26-04.DOC
Sep 27 04 02: 01p Levi 1 - 60-385-5875 p. 1
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