HomeMy WebLinkAboutBLD2004-00767 •
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 #: BLD04-00767 Received Date 12/7/2004
SITE ADDRESS: 191 NESS' CORNER RD Issue Date 12/7/2004
PORT HADLOCK, 98339
APPLICANT: ROBERT A DAY PHONE: (360) 379-0296
CHERI E VAN HOOVER
PO BOX 1658
PORT HADLOCK WA 98339-1658 T 197
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 901023008 Section: 2 Township: 29N 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, ROBERT A DAY PHONE: (360) 379-0296
if different: CHERI E VAN HOOVER
PO BOX 1658
PORT HADLOCK WA 98339-1658
PROJECT DESCRIPTION: EXISTING A/G 250 GAL PROPANE TANK
INSTALLING 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 12/07/2005.
REQUIRED INSPECTIONS:
.416
Tank/Line/Appliance: 6,45 e/2/iUl f A" ,
FinalApproval: � �4Gt— - i n sa-1 /2- V D/
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£
• SITE VISIT REPORT •
(PLOT PLAN)
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ADDRESS PHONE # .
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.UILDING PERMIT APPLICA1SN B Review
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00767 Received Date: 12/7/2004
SITE ADDRESS: 191 NESS' CORNER RD
PORT HADLOCK, 98339
OWNER: ROBERT A DAY PHONE: (360) 379-0296
CHERI E VAN HOOVER
PO BOX 1658
PORT HADLOCK WA 98339-1658
SUBDIVISION: Block: Lot: T 197
PARCEL NUMBER: 901023008 Section: 2 Township: 29 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 EXISTING A/G 250 GAL PROPANE TANK
INSTALLING 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 12/07/04 68788
Total: $48.00
• JEFFERSON COUNTY COMMUNIT•VELOPMENT,621 SHERIDAN ST.PORT TOWNS,WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* Above Ground PROPANE TANK* SIZE OF PROPANE TANK
HEAT STOVE HOT
WATER TANK WOODSTOVE FIREPLACE INSERT PELLE13 VE. 7 n4
COOKING STOVE (Please Specify) eC f2C- 33e1Is this appliance (woodstove, htg stove, hot water to ,furnace, etc.)to be in3Falled in a Manufactured/Mobile
Home?
YES ) . NO
SITE ADDRESS(911 #/Road Name):
/9 / e 1 /1A-I Al
PT-. ZIP fy 37
9 DIGIT PARCEL ID NUMBER 90/ e..� 60
cp
Legal Description:
Subdivision Name Block Lot(s)
'Section Township North, Range � WM
���
APPLICANT ��!/u-f I. 70.14,/qtri) �/ 'f'_ La...1 PHONE -1 7 / 6d F4 •
MAILING ADDRESS Pe) ° /G f77 PC— 6Jc of;' , 7
ZIP
PROPERTY OWNER a.r)-I- 4-e ci .,...7( PHONE (-11)-t)-s` --e _-.i
MAILING ADDRESS aid'j'2.Fr.L c o-,._ i!,'t
ZIP
CONTRACTOR S LA-i1 5 t-i I I) L. 1 )1—(')(1 rvQ._. PHONE 3crs-r 7 S 7
MAILING ADDRESS l U,)c� k0clLi IJr •
Pert- ibc{ L6ck , I,v'19 ZIP (-1 33c/
STATE LICENSE# C l►'1 S.f-i IJ (C-7 J n EXP.DATE 1 (/Q 0
FEDERAL I.D.# c--7 ( ' / C) '/j ;J'J`r
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'- I fir:.-iv is-L �_, DATE /�-/ 7 I �'//
FOR OFFICE USE ONLY
BASE FEE $48.00 RECEIPT#
CONSISTENCY REVIEW ' B --� CASH/CK# 3 I Co
TOTAL 1 r• CO
1 DATE I s/JL/D47 )
,i
*
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