HomeMy WebLinkAboutBLD2004-00707 • 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 #: BLD04-00707 Received Date 11/10/2004
SITE ADDRESS: 260 S PALMER DR Issue Date 11/10/2004
PORT TOWNSEND, 98368
APPLICANT: CHARLES BULLEN PHONE: (360) 385-7016
JO ANNE ETHERIDGE
260 S PALMER DR
PORT TOWNSEND WA 98368 25
SUBDIVISION: CAPE GEORGE COLONY DIV 2 Block: 4 Lot:
PARCEL NUMBER: 938100425 Section: 13 Township: 30N Range: 02W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2006
OWNER, CHARLES BULLEN PHONE: (360) 385-7016
if different: JO ANNE ETHERIDGE
260 S PALMER DR
PORT TOWNSEND WA 98368
PROJECT DESCRIPTION: A/G 120 GAL PROPANE TANK, GAS FIREPLACE, 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 11/10/2005.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: (9 ([i "t.
FinalApproval: CV-- j — t' 11, 'OL
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�
•UILDING PERMIT APPLICA#N BLD04-00707
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00707 Received Date: 11/10/2004
SITE ADDRESS: 260 S PALMER DR
PORT TOWNSEND, 98368
OWNER: CHARLES BULLEN PHONE: (360) 385-7016
JO ANNE ETHERIDGE
260 S PALMER DR
PORT TOWNSEND WA 98368
SUBDIVISION: CAPE GEORGE COLONY DIV 2 Block: 4 Lot: 25
PARCEL NUMBER: 938100425 Section: 13 Township: 30 N Range: 02 W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2006
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI A/G 120 GAL PROPANE TANK, GAS FIREPLACE, 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 KAS 11/10/04 68684
Total: $48.00
uwvry I,IJUIv I Y UUMMUNI I Y UtVLLUF'MbNT,621 SHERIDAN ST,PORT TOWNSEND WA 96368 PH: (360)379-4450
•
IIOALLATION PERMIT APPLICATION 0
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* Above Ground PROPANE TANK* SIZE OF PROPANE TANK / O
6,ks Fe
yHEAT STOVE HOT WATER TANK WOODSTOVE FIREPLACE INSERT PELLET STOVE
COOKING STOVE y OTHER(Please Specify) r'a /
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):
c2 G o S- IPZ,rQ--N (3 r •
P ( - -- ^l7Gt."n4,,n'u49 . tA)a-ZIP `i 3).34
9 DIGIT PARCEL ID NUMBER l 3(J / O O yl_J
Legal Description:
Subdivision Name Block Lol(s)
Section Township North, Range WM
APPLICANT �-
C-1 ..S""k- j JD l4714-- PHONE 8S —/ U/4 .
MAILING ADDRESS c5 c
ZIP
•
PROPERTY OWNER --t—C cL4 PHONE ( / I BC +•.C..f.,
MAILING ADDRESS C>`-L1-'2 L.C 4-1`_L14
ZIP CONTRACTOR St-,St-,L VI5 1-4 iv.) E. )r G 03f,a___ PHONE 3 es c�c 75
-7
MAILING ADDRESS I U e j 3 P 1,106i Lk I,rr •
Po — f.1 dL6ck , 1,v'ii ZIP C] e33
STATE LICENSE# S Lth 1 S 14-P Q_7 7 0 n j I/0 4
EXP.DATE
FEDERAL I.D.# CI j - / v 7 c 8 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,indemnity 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-r,-77 Qom--\__ DATE l(/
/ / U
FOR OFFICE USE ONLY C
BASE FEE $48.00 RECEIPT# ` , .All
CONSISTENCY REVIEW $24.00 CASH/CK# al D 0,6-
TOTAL ___ u,lA
DATE ,. i� / Ial
* ,
Propane Tank applications require additional information to be submitted .rl..___`-.-
Please contact our office at 360-379-4450 If the back of this application Is blalnk. , OVER 1+ 4 4
U ii! NOV 1 U 'uu4
JEFFEH Or OWN ry
G:\PermitCenter\FORMS\BLDG FORMS\install-revised 01-26-04.DOC i I-`i r 1'' '`' ". f ',
SITE VISIT REPORT
(PLOT PLAN)
BILLING CUSTOMER 'Gjur,gt Au,j/rpe1 DATE .
JOB NAME CONTACT .
ADDRESS PHONE # .
DIRECTIONS FAX # .
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