HomeMy WebLinkAboutBLD2004-00635 03UILDING PERMIT APPLIC.ON B Review 0635
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
_RMIT #: BLD04-00635 Received Date: 10/6/2004
FE ADDRESS: 3063 PARADISE BAY RD
PORT LUDLOW, 98365
)WNER: STEVEN B MAHANA PHONE:
KELLY A MAHANA
3063 PARADISE BAY RD
PORT LUDLOW WA 983659760
SUBDIVISION: TALA SHORES #1 Block: Lot: 10
PARCEL NUMBER: 998200109 Section: 22 Township: 28 N Range: 01 E
CONTRACTOR: CUSTOM HEARTH PHONE:
18657 H I W AY 305
POULSBO WA
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION NO MLA REQ'D - A/G 120 GALLON PROPANE TANK & FIREPLACE
INSERT
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
Total:
•
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 #: BLD04-00635 Received Date 10/6/2004
SITE ADDRESS: 3063 PARADISE BAY RD Issue Date 10/6/2004
PORT LUDLOW, 98365
APPLICANT: STEVEN B MAHANA PHONE:
KELLY A MAHANA
3063 PARADISE BAY RD
PORT LUDLOW WA 983659760 10
SUBDIVISION: TALA SHORES #1 Block: Lot:
PARCEL NUMBER: 998200109 Section: 22 Township: 28N Range: 01 E
CONTRACTOR: CUSTOM HEARTH PHONE:
18657 HIWAY 305
POULSBO WA
OWNER, STEVEN B MAHANA PHONE:
if different: KELLY A MAHANA
3063 PARADISE BAY RD
PORT LUDLOW WA 983659760
PROJECT DESCRIPTION: NO MLA REQ'D-A/G 120 GALLON PROPANE TANK & FIREPLACE
INSERT
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 10/06/2005.
REQUIRED INSPECTIONS:
TanWLine/Appliance: '1;N K ,N STA“Ark- OIL k' Visk
FinalApproval:____ (a K Qot Ci VlA. I//3 GS
c#_____
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 1 0/29/19
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JEFFERSON COUNTY COMMU•DEVELOPMENT,621 SHERIDAN ST,PORT TOWNS•A 98368 PH: (360)379-4450 /
INSTALLATION PERMIT APPLICATION '
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS 1r1STALLAT IOI•
Underground PROPANE TANK* ✓ Above Gro,md PROPANE TANK HEAT STOVE HOT WATER TANK
WOODSTOVE ✓ FIREPLACE INSERT PELLET STOVE COOKING STOVE `^�
7
OTHER(Please Specify)_ 'I p/Lt LE' i, e. C� Cl s:_c C j LJ c pip//? c f ``�J
tpliance(htg stove,hot water tank,Onichace,etc.)to be insta,: tie Home?
SITE ADDRESS(911#/Road Name
3P3 Q rzat& kit-4
Pod,jvuor Wiicb (( J g&',.5—ZIP
9 DIGIT PARCEL ID NUMBER ! 1`/Q
Legal Description: ttt///
Subdivision Name Block Lot(s)
Section D' Township North, Range /, WM
APPLICANT �€/// / G/}�4 ' `-� /2 C'- PHONE 366 - y�J f //
MAILING ADDRESS pt,i,3 A f4d/55c_ /`
rf-Gt-tel/r--) / W i . DIP 9.�3eo5 �j
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PROPERTY OWNER jJ f P er-e 4 1 el I Gila/6/1`& PHONE A0/ - L/3 7 < //
MAILING ADDRESS Pa /`d
fr7L Oui l�// ZIP_L_U�10f—
CONTRACTOR
C 'U 11/ e / T`1 PHONE/--360- 373 - /33/
MAILING ADDRESS 330 / V" o �� l '
Pb rf ore W//i% ci31.01 ZIP ?ii30?—
STATE LICENSE# — Su I\1 b.ic}S*-()Lo t.°w)^G-- EXP.DATE 511 1/Ob
FEDERAL I.D.# f. I —_ 41/-�,3 /ze�a
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 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 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 agents for the purpose of application review and any required
later inspections. Access and right of entry/toto the applicant's property� or st ture shall be requested and shall occur during regular business hours.
APPLICANT'S SIGNATURE (�-E-�( �v/ G 4 fA--- DATE 7 /402
/. 4 j7
FOR OFFICE USE ONLY (01 .__q _
/
BASE FEE WOO 5,1 RECEIPT#
CONSISTENCY REVIEWIQIii. CASH/CK# 8/ 3
TOTAL '1O DATE /014 / 01
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 4 a. 4
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OCT 4 2004
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JEFFERSON COUNTY DCD
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JEFFERSON COUNTY DCD