HomeMy WebLinkAboutBLD2004-00703 •UILDING PERMIT APPLICAIN BLD04-00703
Review
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00703 Received Date: 11/9/2004
SITE ADDRESS: 91 WREN CT
PORT LUDLOW, 98365
OWNER: WARREN E BERG TRUSTEE PHONE:
PATRICIA E BERG TRUSTEE
91 WREN CT
PORT LUDLOW WA 983659793
SUBDIVISION: PORT LUDLOW#4 Block: Lot: 9
PARCEL NUMBER: 990500009 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 DESCRIPTION ADDING PROPANE HEATING STOVE -- TANK ALREADY EXISTS
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:
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 By: Date: Receipt: Approved/Date
Permit $48.00 KAS 11/09/04 68679
Total: $48.00 APPROVED
NOV - 9 2004
Jefferson County Planning
& Building Department
:moid"X Vo1/4
*c Ir M % J
_ ,L„��,v 1 r c,.VMMUNI I Y UtVtLUWMILN I,U1 SHERIDAN SL PORT TOWNSEND WA 98368 PH: (360)379-4450
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INSLLATION PERMIT APPLICATIONII, f
4..tiP'vt l
MAR -Att IT-E.V.:F LOW THAT PERTA1N,TO THIS INSTALLATION
Underground PROPANE TANK* X Above Ground PROPANE TANK* SIZE OF PROPANE TANK 1 fr-/`-C
HEAT STOVE HOT WATER TANK \, WOODSTOVE FIREPLACE INSERT PELLET STOVE
COOKING STOVE OTHER(Please Sp city) -u.-4 Cif i..,rt-ei
Is thi liance(woodstove, htg e, hot water tank,furnace,etc.) to be installed in a Manufactured/Mobile
Home?
• YES `\ NO
SITE ADDRESS(911 #/Road Name):
j W /LQ--1 (fir i
9 DIGIT PARCEL ID NUMBER q -6-Do cJ O
Legal Description:
Subdivision Name Block Lot(s)
Section ,� ,^ Township North, Range WM
� 1
APPLICANT W 6'/�r/ (%1,-- 8-e-''5 PHONE y VI- a 3 i 5
•
MAILING ADDRESS 9 ( 1.-a-vi. e--e-74_,-)----7`
ZIP
PROPERTY OWNER C'P--IL-`c cl---$ ' PHONE 7)--p -0'--. t.a .
MAILING ADDRESS Cu-Kill-l-4 r.-C. ,-__Lt4
ZIP ^�
CONTRACTOR S to)1 5 I-I 111 Q- PCG �p 3r PHONE 3 0 5 cJ / 9 1/
MAILING ADDRESS I (-)e j 3 K 11uCl L1 f r
Por^ c iNi3d L 6 k , lik)6 . ZIP 9 e3 3 i
STATE LICENSE# S Lt i•-i -S f-I 0 ›(D-7 7 0 A EXP.DATE I I/0 f!Q
FEDERAL I.D.# C 1 ' / 0 713 s'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 attorney's fees and expenses which may in any
.vay accrue against Jefferson County as a result of or in consequence of the granting of this permit.
i lunher 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 C C , f DATE 1 / ?/ 6
_------ _\ FOR OFFICE USE ONLY BASE FEE _$48.00 RECEIPT# • tc) O G6 ) 9
CONSISTENCY REVIEW CASWCK#
TOTAL DATE / /
Propane Tank applications require additional information to be submitted. •` _.rC \ OVER 4 4 -�
Please contact our office at 360-379.4450 If the back of this application is blank. '•h'
1t
NOV — 9 2004 —.
;3:\PermitCenter\FORMS\BLDG FORMS\install-revised 01-26-04.DW- --
thSON COUNTY
;;.,ft.1N11Y OFVELOPMENT
• I
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 #: BLD04-00703 Received Date 11/9/2004
SITE ADDRESS: 91 WREN CT Issue Date 11/9/2004
PORT LUDLOW, 98365
APPLICANT: WARREN E BERG TRUSTEE PHONE:
PATRICIA E BERG TRUSTEE
91 WREN CT
PORT LUDLOW WA 983659793 9
SUBDIVISION: PORT LUDLOW#4 Block: Lot:
PARCEL NUMBER: 990500009 Section: 17 Township: 28N Ranpe: 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, WARREN E BERG TRUSTEE PHONE:
if different: PATRICIA E BERG TRUSTEE
91 WREN CT
PORT LUDLOW WA 983659793
PROJECT DESCRIPTION: ADDING PROPANE HEATING STOVE -- TANK ALREADY EXISTS
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 11/09/2005.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: �TDV l��tiJ O)e ///z-////,
FinalApproval: )/(. -03r - na V2-4-AW
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 10/29/19c
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