HomeMy WebLinkAboutBLD2004-00708 •
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 #: BLD04-00708 Received Date 11/10/2004
SITE ADDRESS: 220 CONDON LN Issue Date 11/10/2004
PORT LUDLOW, 98365
APPLICANT: ROBERT J STOPPA PHONE: (360)437-0977
ALLISON R STOPPA
220 CONDON LN
PORT LUDLOW WA 98365 37
SUBDIVISION: PORT LUDLOW NO 1 AREA 2 Block: Lot:
PARCEL NUMBER: 990400237 Section: 9 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 J STOPPA PHONE: (360)437-0977
if different: ALLISON R STOPPA
220 CONDON LN
PORT LUDLOW WA 98365
PROJECT DESCRIPTION: A/G 120 GAL PROPANE TANK, GAS 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 11/10/2005.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: L�k'�M -iii� �� ,1 F,yee , w/'� 4 /( //0
Ja IApp roval: !� r - Rai.( 1(/(8/
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£
16ILDING PERMIT APPLICATION BLD04-00708
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00708 Received Date: 11/10/2004
SITE ADDRESS: 220 CONDON LN
PORT LUDLOW, 98365
OWNER: ROBERT J STOPPA PHONE: (360) 437-0977
ALLISON R STOPPA
220 CONDON LN
PORT LUDLOW WA 98365
SUBDIVISION: PORT LUDLOW NO 1 AREA 2 Block: Lot: 37
PARCEL NUMBER: 990400237 Section: 9 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 A/G 120 GAL PROPANE TANK, GAS STOVE AND 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 By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 KAS 11/10/04 68684
Total: $48.00
___ _ ,,,,,I,1/4., ,,v I t I.Vlvuvlulvl I r utvtLOi-MLN I,b21 SHERIDAN ST,PORT TOWNSEND WA 98368 PH: (360)379-4450
re4 INSULATION PERMIT APPLICATION •
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* Above Ground PROPANE TANK* SIZE OF PROPANE TANK /2- v
( - HEAT STOVE HOT WATER TANK WOODSTOVE FIREPLACE INSERT PELLET STOVE
COOKING STOVE OTHER(Please Specify) ,
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):
cad e,C,-, 417 -
Pr. i` /4/� (J �� ZIP l U?b,.J-
9 DIGIT PARCEL ID NUMBER 1 I 0 'f d 0 c, 3 7
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT i `-'•✓ 3 J�'CG(SOY`. 516,19A PHONE 43 7 O F 7 "
•
MAILING ADDRESS S."4
ZIP
PROPERTY OWNER 61 L-LC ct-r 4 PHONE �c•,---Z
a •
MAILING ADDRESS Cz- L-C _Lr4
S ZIP p
CONTRACTOR tit S I-4 1 V1 L PC C,0(T 'r PHONE 2 U 4 5 7 77
MAILING ADDRESS I o ?j 3 K 'TLC Li 1)r .
Por^r f.13aLock , 1,06 . ZIP 9e.3.3 j
STATE LICENSE# Sit Vi S(-P CQ-7 7 G) A EXP.DATE I l/0 4
FEDERAL I.D.# C / - / 0 71 ,Y 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.
runner 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 0-- Cti. )s)) y Q-t-h DATE // / / 6/
FOR OFFICE USE ONLY ¢J
BASE FEE $48.00 RECEIPT# �, 4 3' ?'
CONSISTENCY REVIEW $24.00 CASWCK# , ADS
TOTAL I1 a. )
* DATE /1' / 1U /Q
Propane Tank applications require additional information to be submitted.Please contact our office at 360-3T9.4450 If the back of this application is blankV 1 0 L J`OV E R 4 4 ÷
v:\PermitCenter\FORMS\BLDG FORMS\install-revised 01-26-04.DOC
SITE VISIT REPORT •
(PLOT PLAN)
JOB a:ag. C*,t30 DATE : i ‘P-/' d2(r .
CONTACT:
ADDRESS PHONE #: .
DIRECTIONS FAX #:
Email
PLANER: ‘Z/1- •
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