HomeMy WebLinkAboutBLD2004-00655 OUILDING PERMIT APPLICADN BLD04-00655
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00655 Received Date: 10/18/2004
SITE ADDRESS: 1551 LINGER LONGER RD
QUILCENE, 98376
OWNER: PORT OF PORT TOWNSEND PHONE:
PO BOX 1180
PORT TOWNSEND WA 983680980
SUBDIVISION: Block: Lot: T 19
PARCEL NUMBER: 702251013 Section: 25 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 BOILER, GAS PIPING AND HEAT EXCHANGER INSTALLATION
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: to ( (' 'OL f n2 F&W Landslide
Dll f�J Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 PRB 10/18/04 67800
Total: $48.00
0 •
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 #: BLD04-00655 Received Date 10/18/2004
SITE ADDRESS: 1551 LINGER LONGER RD Issue Date 10/18/2004
QUILCENE, 98376
APPLICANT: PORT OF PORT TOWNSEND PHONE:
PO BOX 1180
PORT TOWNSEND WA 983680980
T 19
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 702251013 Section: 25 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, PORT OF PORT TOWNSEND PHONE:
if different: PO BOX 1180
PORT TOWNSEND WA 983680980
PROJECT DESCRIPTION: BOILER, GAS PIPING AND HEAT EXCHANGER INSTALLATION
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 10/18/2005.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: t Kh GI Ct4 `Vi."--`> t7 kçç c 2(,-ilk
FinalApproval: l I - l b
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 COMMUNIT VELOPMENT,621 SHERIDAN ST,PORT TOWNS WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATIOir ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* Above Ground PROPANE TANK* SIZE OF PROPANE TANK
HEAT STOVE HOT WATER TANK WOODSTOVE FIREPLACE INSERT PELLET STOVE
,COOKING STOVE :4OTHER(Please Specify) g 0 I L G-aJ L. c \.(
Is this appliance (woodstove, htg stove, hot water tank,furnace, etc.)to be installed in a Ma factured/Mobile
Home?
YES NO ;.� ifu.71 TM JIP Ira
SITE ADDRESS(911#/Road Name): '��� '� V
/SS/ L//26--- 6/7 6-&--72 kt7
Q L.cg. i..)A • ZIP q'g .376 OCT 15 2uu4
9 DIGIT PARCEL ID NUMBER 7 D vL S I Q /3
Legal Description: JEFFERSON COUNTY DCD
Subdivision Name Block Lot(s)
Section Township _North, Range WM
APPLICANT C.,D 1 4:1Qy�o0 -s7a PHONE 765 — 33 XS
MAILING ADDRESS ' O Is v yam- �/,3c C
7 /
Q c. c�.�.../ Lt) a ZIP 9 R 3 7
PROPERTY OWNER a- a-kL2_r ci._44 PHONE L7CJ=j ('`--,-( 4
MAILING ADDRESS CL-H'1 L C 6_. (r
ZIP
CONTRACTOR ,S to Yl 5 h( 1 Il L_ pi G p.3,mo.___ PHONE
MAILING ADDRESS 1 v.' ) l0Cl Li 1)r •
Port b.(71 L tick, k\J8 . ZIP ` 3 j
STATE LICENSE# SL t U1 S H 19 c c 7 7 Q A EXP.DATE I I/0 `t
FEDERAL I.D.# C 1 ' / () ,/j 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 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 attorneys 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 orstructure shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE �( C�ti ()(J fit rvt!J (� 1 __ DATE /l� l /3 / ('
//"" FOR OFFICE USE ONLY QQ,�.��/+�
BASE FEE $48.00 RECEIPT# 67 W
CONSISTENCY REVIEW 0. CASH/CK# 3o74-
TOTAL _ ___ __ DATE it 0/ I O / 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