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HomeMy WebLinkAboutBLD2004-00697 BUILDING PERMIT APPLICA1N B RDOe 00697 Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD04-00697 Received Date: 11/5/2004 SITE ADDRESS: 51-D N CHANDLER CT PORT LUDLOW, 98365 OWNER: ROBERT L BETHEA PHONE: (360) 437-4030 JOAN M ANTHONY 51-D N CHANDLER CT PORT LUDLOW WA 98365 SUBDIVISION: INNER HARBOR VILLAGE CONDO Block: Lot: UN 5E PARCEL NUMBER: 961600501 Section: 17 Township: 28 N Range: 01 E 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 DESCRIPTIOr COOKING STOVE AND GAS PIPING TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION MAIN: 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 KAS 11/05/04 68669 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 #: BLD04-00697 Received Date 11/5/2004 SITE ADDRESS: 51-D N CHANDLER CT Issue Date 11/5/2004 PORT LUDLOW, 98365 APPLICANT: ROBERT L BETHEA PHONE: (360)437-4030 JOAN M ANTHONY 51-D N CHANDLER CT PORT LUDLOW WA 98365 UN 5E SUBDIVISION: INNER HARBOR VILLAGE CONDO Block: Lot: PARCEL NUMBER: 961600501 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 11/17/2006 OWNER, ROBERT L BETHEA PHONE: (360)437-4030 if different: JOAN M ANTHONY 51-D N CHANDLER CT PORT LUDLOW WA 98365 PROJECT DESCRIPTION: COOKING STOVE AND 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 11/05/2005. REQUIRED INSPECTIONS: Tank/Line/Appliance: , OK (© d 4 c)5 (fV-- FinalApprov • Ole I is 45 )(xv\‘ 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 VELOPMENT,621 SHERIDAN ST.PORT TOWNSEOA 98368 PH: (360)379-4450 ITALLATION PERMIT AP PLICATION 0 MARK 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 Y COOKING STOVE OTHER(Please Specify) r Is this appliance(woodstove, htg stove, hot water tank,furnace, etc.) to be installed in a Manufactured/Mobile Home? • YES NO SITE ADDRESS(911#/Road Name): ---- i , �"/.� L'cyZ"1 4tJI�ZI P c 0 3 C� S Le 9 DIGIT PARCEL ID NUMBER f 6 ( W Q U S-O Legal Description: Subdivision Name Block Lot(s) Section Township North, Range WM APPLICANT Q0 b...,-7- �f 6�'.,c,�..W-6— PHONE S 7U V MAILING ADDRESS 5 I 0#J . c rzs, C7.. - 0 ,P / 4bt.,6—e• -,„) (..)c- ZIP i PROPERTY OWNER ( I�` cU�7t PHONE -C -C.o MAILING ADDRESS cL C 6,L, ZIP CONTRACTOR S LA 11 5 I-) I r7 - (fi r G 0 a PHONE MAILING ADDRESS 10`SD j 3 P 110 CI LA IJ r • Pol^T f,i3AL6c. k, k)1 . ZIP 3 l STATE LICENSE# S Lt V) -S H.P in-7 7 Q h EXP.DATE 1 1/L)er FEDERAL I.D.# C I - / 0 718 5'1 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 ,i-. C.- (4,-,.j QU--�- - DATE I(/ / e)4/I / U FOR OFFICE USE ONLY c BASE FEE $48.00 RECEIPT# lU O CASWCK# 8 lo S * TOTAL l—}tS .CO DATE I /1L/()Sq- ic2�\ 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