HomeMy WebLinkAboutBLD2004-00768 •
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 #: BLD04-00768 Received Date 12/7/2004
SITE ADDRESS: 63 SEA BREEZE LN Issue Date 12/7/2004
PORT LUDLOW, 98365
APPLICANT: THOMAS J KRUEGER PHONE: (360)437-8167
JOYCE E KRUEGER
63 SEA BREEZE LN
PORT LUDLOW WA 98365 25+
SUBDIVISION: TEAL LAKE VILLAGE Block: Lot:
PARCEL NUMBER: 998700025 Section: 21 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, THOMAS J KRUEGER PHONE: (360)437-8167
if different: JOYCE E KRUEGER
63 SEA BREEZE LN
PORT LUDLOW WA 98365
PROJECT DESCRIPTION: A/G 120 GAL PROPANE TANK, GAS PIPING AND APPLIANCE
HOOK UPS
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:
Tank/Line/Appliance: a/Qs L.0E5 4 SNetr err- 141A/�S 4e,k l��/Pf
ae/9S uc r / 14 L. p �iv�� 4)/LL c.c-r P{{ IT /F TN�7 o�G/D.f
TG /AJ1TAc.c Li,i- z).
FinalApproval: e/,e r 4), .,A—i /112,p5-,k
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 APPLICA1N BLD04-00768
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00768 Received Date: 12/7/2004
SITE ADDRESS: 63 SEA BREEZE LN
PORT LUDLOW, 98365
OWNER: THOMAS J KRUEGER PHONE: (360) 437-8167
JOYCE E KRUEGER
63 SEA BREEZE LN
PORT LUDLOW WA 98365
SUBDIVISION: TEAL LAKE VILLAGE Block: Lot: 25+
PARCEL NUMBER: 998700025 Section: 21 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 PIPING AND APPLIANCE HOOK
UPS
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 2003
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 By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 KAS 12/07/04 68788
Total: $48.00
•
' ! SITE VISIT REPORT •
(PLOT PLAN)
JOB goy0e- / DATE :
CONTACT:
ADDRESS PHONE #:
DIRECTIONS FAX #:
Email
PLANNER:
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DEC - 7 2004
JEFFERSON COUNTY COMMUNITY VELOPMENT,621 SHERIDAN ST,PORT TOWNSEEWA 98368 PH: (360)379-4450
r'
I TALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* Above Ground PROPANE TANK* SIZE OF PROPANI;TANK ic'20
HEAT STOVE HOT WATER TANK WOODSTOVE ' FIREPLACE INSERT PELLET STOVE
COOKING STOVE OTHER(Please Specify) �/► piii,e, c p�l � Q`�C 4-f
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): &
to o sy____ 4"j
Y / / e_ Z U .J ZIP PJ 6
9 DIGIT PARCEL ID NUMBER J 70 Q c .
.5..._
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT th-S X leu e PHONE /� 7 cr/cp 7 '
MAILING ADDRESS
ZIP
•
PROPERTY OWNER C-yia—QL..,_l( cL.t.� PHONE `-P-1 c'`---si( 'a
MAILING ADDRESS a-fdLj2kL C 4-ram_-C,,
ZIP
CONTRACTOR `,t.ti t1 5 hi IY1 (:L. PrC 0 at-�_ PHONE ; cr3—J ? 7
MAILING ADDRESS ��)�� �:6�o Imo. �/ .
Per r ti,"({ L 6( k 6t'd ZIP ci e 3 3`I
STATE LICENSE# (l 1l S f-{OJ X C_/ 7 0 n EXP.DATE I //0 6
FEDERAL I.D.# (-J ( ' / ( '/c1 .YS'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,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 l G,- ) Lr� -/�? 11-1 \___ DATE /' / 7 / e..-; /
FOR OFFICE USE ONLY ���
BASE FEE $48.00 RECEIPT#CONSISTENCY REVIEW $24.00 CASH/CK# 3 I aco
TOTAL 1 cR.00 DATE 1 a Li/ b T -j
*
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.
C:\PermitCenter\FORMS\BLDG FORMS\install-revised 01-26-04.DOC