HomeMy WebLinkAboutBLD2002-00563 ....._. . b • .... ,.
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#: BLD02-00563 Received Date 9/23/2002
SITE ADDRESS: 1891 S JACOB MILLER RD Issue Date 9/24/2002
PORT TOWNSEND, 98368
APPLICANT: ARCADIA REACH LLC PHONE: (360)385-1489
PO BOX 751
PORT TOWNSEND WA 98368-0751
1-10
SUBDIVISION: IRVING PARK ADDITION Block: 13 Lot:
PARCEL NUMBER: 963301301 Section: 16 Township: 30N Range: 01W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2002
OWNER, ARCADIA REACH LLC PHONE: (360)385-1489
if different: PO BOX 751
PORT TOWNSEND WA 98368-0751
PROJECT DESCRIPTION: PROPANE TANK& INSERT INSTALLATION
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 9/2412003.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance. 6 Q yv0 5
[V FinalApproval: C— ` ? ,
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
BLD02-00563
likUILDING PERMIT APPLICN Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD02-00563 Received Date: 9/23/2002
SITE ADDRESS: 1891 S JACOB MILLER RD
PORT TOWNSEND, 98368
OWNER: ARCADIA REACH LLC PHONE: (360)385-1489
PO BOX 751
PORT TOWNSEND WA 98368-0751
SUBDIVISION: IRVING PARK ADDITION Block: 13 Lot: 1-10
PARCEL NUMBER: 963301301 Section: 16 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 11/17/2002
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION PROPANE TANK & INSERT INSTALLATION
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 1997 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 $47.00 MAM 09/23/02 49698
Total: $47.00
•
JEFFERSON COUNTY COMMUNITY DEVELOPMENT.621 SHERIDAN ST,PORT TOWNS ND WA 98368 PH: (360)379-4450
t� INSTALLATION PERMIT APPLICATION
WOODSTOVE Above Ground PROPANE TANK PELLET STOVE OTHER
Is this appliance(htg stove, hot water tank,furnace,etc.)to be installed in a Manufactured/Mobile Home?v/
YES NO
.-SITE ADDRESS(911#/Road Name):
/eft Z' c)) Pii//41-1/
ec- \J e -,-3 ZIP [ (123(- P
9 DIGIT PARCEL ID NUMBER 96 3 3o / 3 o/
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range VVM
APPLICANT t'+ A-19-1/1 AA ,(? - Li-C__ PHONE 8 S JYJI
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MAILING ADDRESS r D ' K /S I /` Z
eJ
9 r ZIP 7 `?
PROPERTY OWNER 7‘11a-p-&- PHONE SA frz-e__)
MAILING ADDRESS (/
ZIP
CONTRACTOR t M1 ✓, PHONE
3(1J 5777
MAILING ADDRESS 6A8J3
Or L4y
ZIP ` d9ii F
STATE LICENSE# $Z'fl!f P )77 O f EXP.DATE ///0 Z.--
FEDERAL I.D.# //- /07 f 83-7
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.
APPLICANT SIGNATURE (2 11 nn l'" DATE 7 / /7 10.1-F
F. n" • USE ONLY
BASE FEE SEP 2 3 2002 RE
_ 9(
TOTAL JEFFERSUN COUNTY
DEPT.OF COMMUNITY DEVE1 ENT �7 --,..5/C .
H:W OME\PLN C NTR\I N F OBLDGIFORMSU N STALL.DOC 11/05/01