HomeMy WebLinkAboutBLD2004-00757 • •
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 #: BLD04-00757 Received Date 12/1/2004
SITE ADDRESS: 341 MC MINN RD Issue Date 12/2/2004
PORT TOWNSEND, 98368
APPLICANT: GEORGE L HAYES TRUSTEE PHONE: (360) 379-3651
LINDA D B HAYES TRUSTEE
PO BOX 1804
PORT TOWNSEND WA 98368-0210 T 11+
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 001072002 Section: 7 Township: 30N Range: 01W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2006
OWNER, GEORGE L HAYES TRUSTEE PHONE: (360) 379-3651
if different: LINDA D B HAYES TRUSTEE
PO BOX 1804
PORT TOWNSEND WA 98368-0210
PROJECT DESCRIPTION: GAS HEAT STOVE
EXISTING TANK
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 12/02/2005.
REQUIRED INSPECTIONS:
Tank/Line/Appliance:
FinalApproval: 9)0(4` L /a-/J=07,
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
OUILDING PERMIT APPLICAAN BLD04-00757
Review
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00757 Received Date: 12/1/2004
SITE ADDRESS: 341 MC MINN RD
PORT TOWNSEND, 98368
OWNER: GEORGE L HAYES TRUSTEE PHONE: (360) 379-3651
LINDA D B HAYES TRUSTEE
PO BOX 1804
PORT TOWNSEND WA 98368-0210
SUBDIVISION: Block: Lot: T 11+
PARCEL NUMBER: 001072002 Section: 7 Township: 30 N Range: 01 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 DESCRIPTION GAS HEAT STOVE
EXISTING TANK
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION
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
Propane Tanks/Stoves $48.00 KAS 12/01/04 68778
Total: $48.00
JEFFERSON COUNTY COMMUNITY DEVELOPMENT.621 SHERIDAN ST.PORT TOWNSEND WA 98368 PH: (360)379-4450
INSTDEALLATION PERMIT APPLICATION.
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION CC _
Underground PROPANE TANK* Above Ground PROPANE TANK* SIZE OF PROPANE TANKl J�'rt.
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 V NO
SITE ADDRESS(911 #1 Road Name):
3 `I( b'1 cfriihh
P i i o Lo n s ekii9 wn ZIP r W d
9 DIGIT PARCEL ID NUMBER 0 ez. ( °7 a-- d O
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM io
APPLICANT v e-.-e/Y-- 1 ( PHONE 3 7 3 S ( .
MAILING ADDRESS P 0
ZIP
PROPERTY OWNER al'14_1L _C cL4.,..1' PHONE C''- --4..''
MAILING ADDRESS Q -i'-f-C 4-1---Ll
ZIP
CONTRACTOR S'-11 5 N I ill L I"fir G p c_���x'-Q PHONE ,g eS s 7 9 7
S MAILING ADDRESS I v'S' 3 c k u ci,..A //
1 f J r •
Por-- ilacl. L rick, 1A))1 . ZIP q 3 j
STATE LICENSE# t--t'V1 -s N n-7 7 Q n EXP.DATE i I/0 ffi
FEDERAL I.D.# C / / 071 S 3'y
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 4 Cti- (iJ 4-t�-�_ DATE 1/ I l U
FOR OFFICE USE ONLY //,., 7
BASE FEE $48.00 RECEIPT# V1 01 '1
CONSISTENCY REVIEW $2470O CASH/CK# c 1 1.
TOTAL 61% DO DATE
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 J i FERSON COUNTY DCO