HomeMy WebLinkAboutBLD2004-00668 • •
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 #: BLD04-00668 Received Date 10/21/2004
SITE ADDRESS: 11524 SR 19 Issue Date 10/21/2004
PORT HADLOCK, 98339
APPLICANT: QUIMPER CREDIT UNION PHONE:
PO BOX 1530
PORT TOWNSEND WA 983680048
SUBDIVISION: SEVENTH AVE ACRE TRACTS Block: Lot:
PARCEL NUMBER: 994200045 Section: 3 Township: 29N 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, QUIMPER CREDIT UNION PHONE:
if different: PO BOX 1530
PORT TOWNSEND WA 983680048
PROJECT DESCRIPTION: NO MLA REQ'D -A/G 120 GALLON PROPANE TANK, GAS PIPING,
& STANDBY ELECTRIC GENERATOR
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 10/21/2005.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: l?C-.tt- T-NsP to►S ReSot-7S tO 2..Z mcif
FinalApproval:Y {i 5--
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
BIR BLD04-00668LDING PERMIT APPLICATI Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
'ERMIT #: BLD04-00668 Received Date: 10/21/2004
SITE ADDRESS: 11524 SR 19
PORT HADLOCK, 98339
OWNER: QUIMPER CREDIT UNION PHONE:
PO BOX 1530
PORT TOWNSEND WA 983680048
SUBDIVISION: SEVENTH AVE ACRE TRACTS Block: Lot:
PARCEL NUMBER: 994200045 Section: 3 Township: 29 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 NO MLA REQ'D - AIG 120 GALLON PROPANE TANK, GAS PIPING,
& STANDBY ELECTRIC GENERATOR
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: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
CONST TYPE: 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
F&W Landslide
Routing Date: Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 CJZ 10/21/04 67886
Total: $48.00
JEFFERSON COUNTY COMMUNITY'ELOPMENT,621 SHERIDAN ST,PORT TOWNSE,A 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* 1 Above Ground PROPANE TANK* SIZE OF PROPANE TANK /20 ((Ut-!
HEAT STOVE HOT WATER TANK WOODSTOVE FIREPLACE INSERT PELLET STOVE
COOKING STOVE x OTHER(Please Specify) J�221�i c tvc/ (f'N `t l ,-et�eu�. 8
Is this appliance (woodstove, htg stove, hot water tank,furnace, etc.) to be installed in a Manufactured/Mobile
Home?
•
YES )C NO
SITE ADDRESS(911 #/Road Name):
//c2gf rSf . P, l91 ' / /�
C?L• �ictdlUc' '/ �`/ 4 ZIP CiY33
9 DIGIT PARCEL ID NUMBER q 2_400 Q G/S
Legal Description: /
Subdivision Name veu-+i. rr2-- °vim �`«4 /U 5 Block E �� Lot(s) J.STLS.p) /cS/sfe/ 157
Section 3 Township 7'7 _North, Range I .( WM Ss
APPLICANT Oj^LL p ( ._,, 411,4 e,G? PHONE E - le 3
MAILING ADDRESS ` _ /
Pa .�,t s-e.44 L �..E �(- ZIP q fi3Ca
PROPERTY OWNER PHONE c)-/,i 1-'s"--
MAILING ADDRESS `,Lti'2x c < lw
ZIP
CONTRACTOR _ - LA l j > hi I F l �'_ )f_ �) f PHONE
MAILING ADDRESS i U� > 1 kid Li ✓ •
Pc 1-1- L, 6 ZIP cj e 3 cl
STATE LICENSE# t t� S H)) ><C.' i l Q A EXP.DATE
FEDERAL I.D.# Cu / • / () /`i r:f 17
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.
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 duiing regular business hours.
APPLICANTS SIGNATURE C�. ti,�,7 11-t �_ DATE /0 l / l C i
FOR OFFICE USE ONLY ��386
BASE FEE $48.00 RECEIPT#
CONSISTENCY REVIEW $24.00 CASH/CK# 30 RO
TOTAL 7Z,06 DATE /0 /
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.
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