HomeMy WebLinkAboutBLD2004-00643 UILDING PERMIT APPLICAlb.
N Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00643 Received Date: 10/11/2004
SITE ADDRESS: 462 BAYCLIFF DR
PORT TOWNSEND, 98368
OWNER: BEVERLY I BENTLEY PHONE: 360 379 3307
462 BAYCLIFF DR
PORT TOWNSEND WA 98368
SUBDIVISION: KALA POINT#5 Block: Lot: 251
PARCEL NUMBER: 965000139 Section: 27 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 DESCRIPTION 120 GAL ABOVE GROUND PROPANE TANK AND PIPING
(REPLACEMENT)
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
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 #: BLD04-00643 Received Date 10/11/2004
SITE ADDRESS: 462 BAYCLIFF DR Issue Date 10/11/2004
PORT TOWNSEND, 98368
APPLICANT: BEVERLY I BENTLEY PHONE: 360-379-3307
462 BAYCLIFF DR
PORT TOWNSEND WA 98368
251
SUBDIVISION: KALA POINT#5 Block: Lot:
PARCEL NUMBER: 965000139 Section: 27 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, BEVERLY I BENTLEY PHONE: 360-379-3307
if different: 462 BAYCLIFF DR
PORT TOWNSEND WA 98368
PROJECT DESCRIPTION: 120 GAL ABOVE GROUND PROPANE TANK AND PIPING
(REPLACEMENT)
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 10/11/2005.
REQUIRED INSPECTIONS:
FinalApproval:_—a/‹.__!��/y
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_F'ermit_Propane.rpt 10/29/19
JEFFERSON COUNTY COMMUNI,EVELOPMENT,621 SHERIDAN ST,PORT TOWNSili WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICAT'IO
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION /w
Underground PROPANE TANK* r\Above Ground PROPANE TANK SIZE OF PROPANE TANK
HEAT STOVE HOT WATER TANK WOODSTOVE FIREPLACE INSERT PELLET STOVE
COOKING STOVE OTHER(Please Specify) J'(A4-
J P (r
Is this appliance (woodstove, htg stove, hot water tank,furnace, etc.))to be installed in a Manufactured/Mobile
Home? \/
YES I`' NO
SITE ADDRESS(911 #/Road Name):
� 3 T . AA-et.," 6Z-4—it—.
p ( ZIP L srf_3 6 a'
9 DIGIT PARCEL ID NUMBER 9 5 000 (/3 7
Legal Description:
Subdivision Name Block Lot(s)
Section Township _North, Range WM
APPLICANT 31,4,,�-/� "�//�'1 /� PHONE ,37 9 -3 3 a 7
MAILING ADDRESS .f6' 2- /34 c. 4// •
�/CJ ZIP
PROPERTY OWNER a-ef'J- -t.-!' ri_.+,. PHONE C-17.11-1-5 -0 C :'3
MAILING ADDRESS Ci- 2ii-C (- 4-r.__L4
ZIP
CONTRACTOR S LA.)1 5 N Ih E. Pi C r (a� _ PHONE
MAILING ADDRESS 1 v'SD ....) 1'1 uCI Lif J r •
Po r r t-4 3 ct L ro c k 1,)✓') ZIP (-) e'3 3 j
STATE LICENSE# S Lth s 1-4 P D 17 Q P EXP.DATE i i/L)
FEDERAL I.D.# C' l - l 07`i e5'7
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 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 to the applicant's property or structure shall be requested and shall occur during regular business hours. '7
APPLICANTS SIGNATURE `�. t --r,� D-1__' DATE 11 / 1[ / r y
--')------ FOR OFFICE USE ONLY ��
BASE FEE $48.0 RECEIPT#
CONSISTENCY REVIEW $24.00 CASH/CK# '1 0
TOTAL DATE 1V di_of
Propane Tank applications require additional information to be submitted. OVER Please contact our office at 360-379-4450 if the back of this application is blank.
G:\PermitCenter\FORMS\BLDG FORMS\install-revised 01-26-04.DOC