HomeMy WebLinkAboutBLD2004-00709 • 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 #: BLD04-00709 Received Date 11/10/2004
SITE ADDRESS: 86 PARKVIEW LN Issue Date 11/10/2004
PORT LUDLOW, 98365
APPLICANT: AL MINISH PHONE: (360)437-9174
JANE MINISH
86 PARKVIEW LN
PORT LUDLOW WA 98365-9718 4
SUBDIVISION: BRIDGE VIEW ESTATE TR DIV II Block: Lot:
PARCEL NUMBER: 821355016 Section: 35 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, AL MINISH PHONE: (360)437-9174
if different: JANE MINISH
86 PARKVIEW LN
PORT LUDLOW WA 98365-9718
PROJECT DESCRIPTION: REPLACE EXISTING TANK W/A/G 500 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: Emg-ki ' IIF--TAy_k_J F_505- ik,4 l,.PC-
007 1(1(4/0L/ se
FinalApproval: � Q�naJ Ik (a 161/
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
ICILDING PERMIT APPLICA•N BL Review T Ty y709
pe:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00709 Received Date: 11/10/2004
SITE ADDRESS: 86 PARKVIEW LN
PORT LUDLOW, 98365
OWNER: AL MINISH PHONE: (360) 437-9174
JANE MINISH
86 PARKVIEW LN
PORT LUDLOW WA 98365-9718
SUBDIVISION: BRIDGE VIEW ESTATE TR DIV II Block: Lot: 4
PARCEL NUMBER: 821355016 Section: 35 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 REPLACE EXISTING TANK W/A/G 500 GAL PROPANE TANK, GAS
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 Bv: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 KAS 11/10/04 68685
Total: $48.00
Liwvw LA-WIN I r IrUMMUNI I Y uhvtLUFMEN I.621 SHERIDAN ST.PORT TOWNSEND WA 98368 PH: (360)379-4450
INSIVATION PERMIT APPLICATION •
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
n
Undergr and PROPANE TANK* Above Ground PROPANE TANK* SIZE OF PROPANE TANK 5O 0 (,�
VHEAT OVE HOT WATER TANK WOODSTOVE 'FIREPLACE INSERT PELLET STOVE
COOKING STOVE OTHER(Please Specify) .lrJ - ,
v,J
Is this appliance(woodstove, htg stove, hot water tank,furnace, etc.)to be installed in a MariufactpredtMibile` i(.11
Home?
• ____
YES NO NOV 1 0 2004 L...'
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SITE ADDRESS(911 #/Road Name):
JEFFERSGN COUNTY
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Zr rt>fl' f'E`•'ELOP�4Ef1T
9 DIGIT PARCEL ID NUMBER g� ( 3 SS Q f C
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT 4 L
1 kJ/..- ___ IV)Ih/,a. PHONE 1 u�? - '(, /�/
.
MAILING ADDRESS v ( _
ZIP
PROPERTY OWNER 0- LC (L., PHONE C`�)-j -c.------/-- ,
MAILING ADDRESS a- 2-LL-C. o-r._,'C,t
ZIP
CONTRACTOR S f-c►1 5 hi I y) Q.
(-'r C n c r& PHONE
MAILING ADDRESS (-3��j l
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Por - dLC}ck L'Jr . ZIP (ie.;3 1
STATE LICENSE# Si(Vi S(4 f7 C o 7 7 0 A EXP.DATE l I/0 6
FEDERAL I.D.# ' 1 ' / 0 7 c 8 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
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 C.- fa'I l,i )-7,9 Q U DATE 7/
! l U
FOR OFFICE USE ONLY /
BASE FEE $48.00 RECEIPT# Ib pc
Lpr:D
CONSISTENCY REVIEW $24.00 CASH/CK# • 1b w
TOTAL - 1 c•1.iO DATE J 1 / .)c /al*
Propane Tank applications require additional information to be submitted.
Please contact our office at 360-379-4450 If the back of this application Is blank. OVER f.
G:\PermitCenter\FORMS\BLDG FORMS\install-revised 01-26-04.DOC
Nov 10 04 03: 5Gp L. 1 -410-385-5875 p. 1
SITE VISIT REPORT
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