HomeMy WebLinkAboutBLD2004-00647 • •
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 #: BLD04-00647 Received Date 10/13/2004
SITE ADDRESS: 61-B CHANDLER CT Issue Date 10/13/2004
PORT LUDLOW, 98365
APPLICANT: LINDA A KARP PHONE:
72 MCKENZIE LN
PORT LUDLOW WA 98365
SUBDIVISION: INNER HARBOR VILLAGE CONDOS Block: Lot:
PARCEL NUMBER: 961600402 Section: 17 Township: 28N Range: 01 E
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2004
OWNER, LINDA A KARP PHONE:
if different: 72 MCKENZIE LN
PORT LUDLOW WA 98365
PROJECT DESCRIPTION: NO MLA REQ'D - FIREPLACE INSERT & GAS PIPE & METER
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 10/13/2005.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: J,// E 0,o/v #
6a1Approval: `9 or C D // /L 4V
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
1 -
• BLD04-00647
BUILDING PERMIT APPLICMON Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00647 Received Date: 10/13/2004
SITE ADDRESS: 61-B CHANDLER CT
PORT LUDLOW, 98365
OWNER: LINDA A KARP PHONE:
72 MCKENZIE LN
PORT LUDLOW WA 98365
SUBDIVISION: INNER HARBOR VILLAGE CONDOS Block: Lot:
PARCEL NUMBER: 961600402 Section: 17 Township: 28 N Range: 01 E
CONTRACTOR: PHONE:
PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP NO MLA REQ'D - FIREPLACE INSERT & GAS PIPE & METER
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 2003 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: # OF STORIES:
OCCUPANCY: 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 Bv: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 CJZ 10/13/04 97862
Total: $48.00
JEFFERSON COUNTY COMMUNITY•ELOPMENT,621 SHERIDAN ST.PORT TOWNSEN•A 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION -�
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION •
,.,
_Underground PROPANE TANK* Above Ground PROPANE TANK* SIZE OF PROPANE TANK OCT2
1 2004
HEAT STOVE HOT WATER TANK WOODSTOVE FIREPLACE INSERT • PELLET STOVE
COOKING STOVE OTHER(Please Specify) 5p ? Z r ,
Is this appliance (woodstove, htg stove, hot water tank,furnace, etc.) to be installed in a Manufactured/Mobile '
Home?
•
YES A NO
SITE ADDRESS(911 #/Road Name):
—eD `-)7L
9 / ZIP
G �/9 DIGIT PARCEL ID NUMBER l ( 6 0v v°v
Legal Description:
Subdivision Name Block Lot(s)
Section 7� Township North, Range(! �-7 WM
APPLICANT ,\ PHONE / 3 '/7 d
MAILING ADDRESS 2
_ �' - ZIP (17?6 J
PROPERTY OWNER °10`3-/1-.L_C cLr 4• PHONE -7-1 --C +- i
,MAILING ADDRESS • r C4 •
ZIP
CONTRACTOR ,S ►1 S h-I I11 L PcG 0 c71.r�L PHONE 3 O S^ 7 7
MAILING ADDRESS ! )'? ) R ' L)d(-.k
Pori •13dLock IA)19 ZIP 3ci
STATE LICENSE# L t" -S H P 7 7 Q A EXP.DATE t (/0 Lt
FEDERAL I.D.# C ( / Ca `J`I Y S'1
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 agems 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,. l�/l`�'� In r✓ L��1 l DATE // / / 7
FOR OFFICE USE ONLY /
BASE FEE ( $48.00 RECEIPT# (o (paZ
CONSISTENCY REVIEW $24.00 CASH/CK# 30k3.Q
TOTAL DATE IO /I a /
�k
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