HomeMy WebLinkAboutBLD2004-00691 • •
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 #: BLD04-00691 Received Date 11/3/2004
SITE ADDRESS: 175 JOLIE WAY Issue Date 11/3/2004
PORT TOWNSEND, 98368
APPLICANT: LANCE RENNIE PHONE:
TRACY RENNIE
175 JOLIE WAY
PORT TOWNSEND WA 98368
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 001071012 Section: 7 Township: 30N Range: 01W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2006
OWNER, LANCE RENNIE PHONE:
if different: TRACY RENNIE
175 JOLIE WAY
PORT TOWNSEND WA 98368
PROJECT DESCRIPTION: NO MLA REQ'D -A/G 120 GALLON PROPANE TANK, GAS PIPING
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 11/3/2005.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: (�,,,./� / l v.-ci efik. a Lk--D4-o
FinalApproval: et yl-04,.-
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
Bi_DING PERMIT APPLICATId BLRDOe 006691
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00691 Received Date: 11/3/2004
SITE ADDRESS: 175 JOLIE WAY
PORT TOWNSEND, 98368
OWNER: LANCE RENNIE PHONE:
TRACY RENNIE
175 JOLIE WAY
PORT TOWNSEND WA 98368
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 001071012 Section: 7 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 11/17/2006
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI' NO MLA REQ'D - A/G 120 GALLON PROPANE TANK, GAS PIPING
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 11/03/04 67898
Total: $48.00
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JEFFERSON COUNTY COMMUNITY DEVF OPMENT.621 SHERIDAN ST.PORT TOWNSEND.8368 PH: (360)379-4450
INSULATION PERMIT APPLICATION
K ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
_Underground PROPANE TANK* /` Above Ground PROPANE TANK* SIZE OF PROPANE TANK /1)-6
_HEAT STOVE HOT WATER TANK WOODSTOVE FIREPLACE INSERT PELLET STOVE
_COOKING STOVE y OTHER(Please Specify) yr
this appliance(woodstove, htg stove, hot water tan ,furnace,etc.)to be installed in a Manufactured/Mobile
ome?
• YES NO
;ITE ADDRESS(911#/Road Name):
/ 7S— i L c
ZIP Vf3646
9 DIGIT PARCEL ID NUMBER 111 CJ ( C�� /7 (
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT / 61
4 PHONE U J S 3S .
MAILING ADDRESS
ZIP
PROPERTY OWNER -' j-- cL4. PHONE
MAILING ADDRESS a- '1-a-L-c. 'CA
ZIP
CONTRACTOR S Lti h S I-I 111 fQ- Pi G O PHONE
MAILING ADDRESS //I��0,?ci) 13 K1'10C1L.j r •
J�dL tic k , tA) ZIP (-1 3 c/
STATE LICENSE# i t o s H P k D ] 70 EXP.DATE I I/0L,
FEDERAL I.D.# C I ' / 071 8 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 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 CA— ti- - o 4 l DATE // / / / U
FOR OFFICE USE ONLY ���
BASE FEE $48.00 RECEIPT#
CONSISTENCY REVIEW $24.00 CASH/CK# 3/0 0
J
2
TOTALla
DATE // 1 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