HomeMy WebLinkAboutBLD2004-00648 BUILDING PERMIT APPLICA•N BL
Revviewiew T Ty648
ype:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00648 Received Date: 10/13/2004
SITE ADDRESS: 750 BLUE SKY DR
PORT TOWNSEND, 98368
OWNER: DAVID 0 SCHORES PHONE:
TERRY SCHORES
PO BOX 357
PORT HADLOCK WA 983390357
SUBDIVISION: DISCOVERY RIDGE DIV III Block: Lot
PARCEL NUMBER: 001195107 Section: 19 Township: 30 N Range: 01 W
CONTRACTOR: PHONE:
PHONE:
REPRESENTATIVE: PHONE
PROJECT DESCRIPTIOP NO MLA REQ'D - COOKING STOVE & GAS PIPE
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION
CODE EDITION: 2003 ADD'L: HEAT TYPE:
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: # OF STORIES:
CONST TYPE: OTHER: SHORELINE
CONST TYPE: GARAGE: 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 CJZ 10/12/04 67861
Total: $48.00
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 #: BLD04-00648 Received Date 10/13/2004
SITE ADDRESS: 750 BLUE SKY DR Issue Date 10/13/2004
PORT TOWNSEND, 98368
APPLICANT: DAVID 0 SCHORES PHONE:
TERRY SCHORES
PO BOX 357
PORT HADLOCK WA 983390357
SUBDIVISION: DISCOVERY RIDGE DIV III Block: Lot:
PARCEL NUMBER: 001195107 Section: 19 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, DAVID 0 SCHORES PHONE:
if different: TERRY SCHORES
PO BOX 357
PORT HADLOCK WA 983390357
PROJECT DESCRIPTION: NO MLA REQ'D -COOKING STOVE & GAS PIPE
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:
FinalApprova( —�=�-U(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 10/29/19�
JEFFERSON COUNTY COMMUNITY EVELOPMENT,621 SHERIDAN ST.PORT TOWNS WA 98368 PH: (360)379-4450
IIISTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION I I
Underground PROPANE TANK* Above Ground PROPANE TANK* SIZE OF PROPANE TANK r'
OCT 2 1 '21-
HEAT STOVE HOT WATER TANK WOODSTOVE FIREPLACE INSERT PELLET STOVE
w
KCOOKING STOVE n/ OTHER(Please Specify)
Is this appliance(woodstove, htg stove, hot water ank, furnace, etc.)to be installed in a ManufhCtured/Mobile
Home?
YES ' NO
4
SITE ADDRESS(911#/Road Name):
'75O 131uP P-t-/ 0(-
Pi i .0(dOirt sert. a &) ► ZIP q U 36
9 DIGIT PARCEL ID NUMBER C Q ( - 1 ! J / O 7
Legal Description:
Subdivision Name BlocK Lot(s)
Section Township _North, Range WM
APPLICANT P`�11fn r r "�� ��-! PHONE 2�S -e27 9(
MAILING ADDRESS 5 (.t..
ZIP
•
PROPERTY OWNER 0- L—c ci_s,4 PHONE - - ^--e`'
MAILING ADDRESS `t- 21•-L C a-r-_.Cq
ZIP
CONTRACTOR S I A-Y) 5 N I11 fQ PC C.,p a -42.__ PHONE
MAILING ADDRESS I t- c. 3 ►C`"luc{Li IJ r •
Po r-f- f 3 ct l_ O c.k, 6"J 1 . ZIP C'i 3 j
STATE LICENSE# S Lt)l S H r) C O.7 7 Cal A EXP.DATE I 1/0
FEDERAL I.D.# Ci 1 ` I 0 Vj ry S'/
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 appiicanUowner 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 cost;,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.
APPLICANTS SIGNATURE y"',( Cti.. /4-r,..70 ,C1-I1--1,_, DATE /O / G / o,
FOR OFFICE USE ONLY �� I
BASE FEE $4H.0O RECEIPT#
CONSISTENCY REVIEW $24.00 CASH/CK# 30lo8
TOTAL DATE JO / Ia/
*
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