HomeMy WebLinkAboutBLD2014-00243 - MECHANICAL EIMLDING PERMIT APPLICATI• BLD14-00243
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD14-00243 Received Date: 7/14/2014
SITE ADDRESS: 821 THORNDYKE RD
PORT LUDLOW, 98365
OWNER: GARY GRIFFITH PHONE: 360-344-2300
13149 SAN ANTONIO AVE
CHINO CA 91710-6905
9351
SUBDIVISION: Block: Lot: 11
PARCEL NUMBER: 935100010 Section: 9 Township: 27 N Range: 1 E
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2014
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION NEW PROPANE TANK 120 gallon
For Fireplace Insert
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP MEC MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 2012 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total: Total:
IRouting Date:
Type Amount Paid By: Date: Receipt: APPROVED Approved/Date
Permit $228.00 SRE 07/14/14 14880
Total: $228.00 JUL 14 2014
Jefferson County DCD
\\tidemark\data\forms\F_BLD_App_Bld.rpt 7/14/2014
07/28/2014 08: 13 FAX 38038558 SUNSHINE PROPANE 21001/001
•
SITE VISIT REPORT
r (PLOT PLAN) Re u t S e d
JOB - C'(1 LL DATE: 4J! '3 1 t 11 fi L t1'
CONTACT: ,,�
ADDRESS 11/1 "c 0� 'N 0 q IL2 1 PHONE #: LA
DIRECTIONS FAX #: Y
Email
PLANNER: =1 I_ —-
In .- .1 eet names ad'acent to •ro•e •r••-I% 'es tank a••liance& •i.in i• a i 4,_ •istances of tank to •r••=I, _:nes and
buildings,sciatic, - and areas,distance to water bodies,
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, JEFFERSON COUNTY roolik6 DEPARTMENT OF COMMUNITY DEVELOPMENT
"4 621 Sheridan Street• Port Townsend •Washington 98368
360/379-4450 . 360/379-4451 Fax ;
' www.co.efferson:wa,us/commdevelo p ment
ITN'
Master Permit Application MLA:
Project Description(include separate sheets as necessary):
■Tax Parcel Number. c1'J L5 J C)D 0 I. U Property Size: (acres/sq,ere feet)
Site Address and/or Directions to Property:
Property Owne s) f Record: l i t%t i T I.
Telephone: 3.' '-300 Fax: email:
Mailing Address; S`Lt ` -4-kt iUJ b ‘e,.. '
_ 1
Applicant/Agent if different from owner): a5
Telephone: w —S"lq''I Fax: ,email: firr► o ,E4A/1'I6h i 11 s ia,
Mailing Address: I.O%S 3 e_t\o Q k 1/482_. •er- -t 1 ci '. 11 ,.:
What kind of Permit?(Check each box that applies
OBuilding ❑Critical Areas Stewardship Plan r.. C®;- �/�
O Demolition Permit 0 Variance(Minor,Major or Reasonabl t=om -a! U V rE
❑Single Family ❑Garage Attached/Detached 0 Conditional Use[C(a),C(d),or Cj** a
• Manufactured Home ❑ Modular 0 Discretionary"D"or Unnamed Use C floation 1;
O Commercial* 0 Special.Use(Essential Public Facilili ,,
O Change of Use 0 Boundary Line Adjustment JUL 1 4 . 2014
❑ Address ❑Road Approach. 0 Short Plat**
O Home Business ❑Cottage Industry 0 Binding Site Plan"* `'
❑Propane 0 Long-Plat** JEFFERSi' COUNTY
❑Sign 0 Planned Rural Residential Development 1tRR9N:, : ■I IPtittONIENT
O Allowed"Yes'Use Consistency Analysis ❑Plat Vacation/Alteration**
0 Stonnwater Management 0 Shoreline Master Program Exemption/Permit Revisions I,:
0;Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development** i°
O Temporary Use 0 Shoreline Management Variance
0 Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amen' ntent
0 Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendmerr,
*May require a Pre—Application Conference 0 Tree Vegetation Request
"Requires a Pre-Application Conference
Please identify any other local,state or federal permits required for this proposal, if known: a'
I hereby designate W.° to as my agent in matters relating to this application for pe .it(s).
‹ OWNER SIGNATURE i�7 Y r
By signing this app icatio form,t - owner/ • nt attests that the information provided,herein,and in any attachments,is true and correct tot a best,of
his,her or its knowledg-. Any m=terial Pals- ood or any omission of a material fact made by the owner/agent with respect to this appiicationl a acket
may result in this permit being null and void. I
I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fee h,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'
I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of=••iication
review and any re• red later' -pectin S ffs access and right of entry will be assumed unless the applicant informs the County in wntin a at the
time of the ap•i j•n that h- ors .' ��,;•__.
" ' s = o .
Signature: A ®�iiW4P
g IIl/�r sio�.►
The actin or.acti sApplican II un• , =ke as a result of the issuance of this permit may negatively impact upon one or more threatened o�
S and or"lead t.- en "take"of an endangered species as,those terms are defined in the federal law known as th'
g- potential
"Endangered p " . ffa County makes no assurances to the applicant that the actions that will be undertaken.becaus-!this
permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regal.;ing your
action(s)even if you re in compliance w th-Jefferson County development code.The Applicant acknowledges that he she or it holds'ind.idual non-transfe -•respons ility fo •'f e ,,to and complying with the ESA. The Applicant has read this disclaimer and signs and dates; below.
( Signature: AGA., i/ `..�(/' 7 /
G:\ ermi - ter Master Permit Application '
P \# \D \
410 1
BUILDER STATEMENT
The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contracto;>and that
they will be assumingg thhee responsiibJi�ity,of the General Contractor for the proposed project: , G�
signature: �.cli t_� �CtY/1ti Date: —7 i� L i I
r r I % /, .� rm.
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: L. v.. C I V 1. III
MAILING ADDRESS: EMAIL: .. ;' 11111
CONTRACTOR'S LICENSE '
WAINS
NUMBER: NUMBER � i 1
1111 1...)./
ARCHITECT/ENGINEER: PHONE ( )
MAILING ADDRESS: EMAIL i • I OMMUNITY DEVE'r`PMENT
Project Type: Frame Type: Bathrooms: Shorelin ype o Sewage Disp•'sal:
o New ❑ Wood Existing:9 0 Sewer
o Addition 0 Steel Proposed: Bank ❑ Community System,
0 Alteration/Remodel o Concrete Total: Height: ❑ Individual System 1
o .Repair ❑ Masonry SEP Permit#
Demolition ❑ Other: Bedrooms: Water Supply: ;
Existing: Setback: ❑ Private well 0 T, o Party
Type of Heat: Proposed: ❑ Public '
Total: Name of System:
,i
If this Is a Commercial Protect you must answer the following:
Number of Parking Spaces: Current: Proposed: Number of IQ Parking Spaces:.
Number of occupants(includes owners,tenants,employees,etc) Current Proposed ,.
IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No i
If this Is a Pt. •.1- ank and/or A. •(lance Installation.ermit mark :II items below tha . • .I :
I Underground Tank Above ground-TAM) Size of Propane Tank: E j i
I Heat Stove I Cook Stove T Woodstove ire se F la lnserr)I Hot Water Tank 1 Pellet Stove i Other ZC---
Is this appliance being installed in a Manufactured I Mobile Home? Yes / No I,
When applying fora permit to install a propane tank you must also submit a site plan showing all of the buildings,alli'•roperty
lines,tank location and size,distances from the propane tank to all property lines,buildings and septic system coin•'•nents,
including the reserve area.
i71HY''',1 y a 1 1
S•uare Foota,a Current Proposed J::.4,1?:1:0-1";,,` 6� ;∎,'T'ili,'� , s ; , W iL i ' , �i,' '''
Main Floor Heated ,',a f*j`b4i S EH Bld App Review:
{rs} 4 'i Consistency Review:
2"0 Floor Heated r r
, Q
,TI Other Heated ; ,' Base fee: �f� j
Mezzanine „.
Additional Section: ,
Heated Basement -
m Plan Check fee:
Unheated Basement t x t t e r' State Surcharge fee: I
I
}Other Unheated f ,, Pot Water Rev'.wfee: I
1
/4 'y I
Garage/Carport , {11 y SUBTOTAL 11
Decks 1" ';a ' 911/Rd Approach fee:
e'
Other '
a�� _1'116.14'1 TOTAL: $ .
R
Receipt Number: /4 O 3v
-i ,. L; Cash/Check Num ber: 6
ESTIMATED COST(REQUIRED) Date: ` ,/ I'
�/
•Fair market value of all labor and materials foundation to finish / /4 i s
Initials: ' f� �/
TJLL _
G:\PemritCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc
I!.
•
SITE VISIT REPORT
(PLOT PLAN)
1 Y DATE: i' v l i l •
JOB. '� -
CONTACT:
ADDRESS T1 O 1612- 14-00-` PHONE #: •
DIRECTIONS FAX #;
Email
PLANNER:
Include all street names adjacent to property,property lines,tank,appliance&piping locations,distances of tank to property lines and
buildings,septic,wells,wetland areas,distance to water bodies.
B
710 L 1\ k Y W tra4
NI
F1Q�
3
-�' Esc►S.4.7%n �
JUL 1 4 2014
p xI
JEFFERSON COUNTY
DEPT.'bF COMMUNITY 1)F4tFLOPh11ENT ,
l2_O R61 l I V1 $ Pt .tf∎
\\Sunshinel\E\BUSINESS\FORMS\PROJECT PLANNING\SITE VISIT REPORT-PLOT PLAN,doc
• , . JEFFERSON COUNTY
' DEPARTMENT OF COMMUNITY DEVELOPMENT ii
621 Sheridan Street• Port Townsend •Washington 98368 li
441,11 360/379- 450 • 360/379-4451 Fax
wwwco.Jeffersonwa.us/commdeve
lopment
Master Permit Application MLA:
Project Description(include se arate sheets as n ssary):
Tax Parcel Number: ?) 1 0 DO I U Property Size: (acres/sgbare feet)
i*
Site Address and/or Directions to Property:
\
l MD`0 V- Q 4. o( { l_..LA.O Lb l,�l
Property Owne s) f Record: (CA 124 Cvt2.1 e r 1 1-1-4
1.
9 li
Telephone: 3 � 2300 Fax: email: ,.
Mailing Address; 3-1 n � i
Applicant/Agent(if different from owe a5u f.1S-N►i• i2cD P i
Telephone: w -S 1.9-1 Fax: email: k WI, r ,to ss
Mailing Address: l O%5 3 Q.t10 011\ 'el- - 30bCA-c___- `l
What kind of Permit?(Check each box that applies
OBuilding ❑Critical Areas Stewardship Plan
Demolition Permit ❑Variance(Minor,Major or Reasonabl -A_ t.
Single Family ❑Garage Attached,!Detached 0 Conditional Use[C(a),C(d),orCj** t
Manufactured Home- 0 Modular 0 Discretionary"0"or Unnamed Use C fication
O Commercial* 0 Special Use(Essential Public Facil'rfi ii,,
O Change of Use 0 Boundary Line Adjustment J A L 1 4 2014
❑ Address 0 Road Approach 0 Short Plat**
O Home Business ❑Cottage Industry 0 Binding'Site Plan**
❑Propane 0 Lon nPlat**
jEFFERSI IC
Sign ❑Planned Rural Residential Development t BH90 Tgiett
NyNENT
❑Allowed"Yes'Use Consistency Analysis 0 Plat Vacation/Alteration'*"
❑Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions*"
O Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development** ;1
0 Temporary Use ❑'Shoreline Management Variance 1.'
❑Wireless Telecommunication* ❑Comprehensive Plan/UDC/Land Use District Map Amendment
0 Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendmen
*May require a Pre-Application Conference 0 Tree Vegetation Request i
"Requires Please identify any other local,state or federal permits required forthis proposal,if known: 1
DESIGNATION OF AGENT
Thereby designate to act as my agent in matters relating to this application for permit(s).'
<- OWNER SIGNATURE4, ���f s ais� Date. 7/0 f L 1j
By signing this app Icatio orm,t - owner/ • nt attests that the Information provided herein,and in any attachments,is true and correct to ,e best of
his,her or its knowledg-. Any m=terial this- ood or any omission a material fact made by the owner/agent with respect to this application�'"'acket
may result in this permit being null and void. i;
I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fee 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 its employees,representatives or agents for the sole purpose of-•plication
review and any re• red later i <pectio.. S Ws access and right of entry will be assumed unless the applicant informs the County in wntin•,at the
time of the ap•i i•n that h_ or sh -;;.• .
4I1/1/.�iII/or {{��
Signature: - �9✓` ®A�ervw� Dg:
The actio or acti sApplican ill un•--ake as,a result of the Issuance of this permit may negatively impact upon one or more threatened o;.
endang=reds 'es and co • lead t• - potential"take"of an endangered species as those terms are defined in the federal law known as the
"Endangered Species Act"or"ESA."J_fferson County makes no assurances to the applicant that the actions that will be undertaken b s ecau -!{his
permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangeredspecies raga ,ling your
action(s)even if you -re In compliance w th Jefferson County development code.The Applicant acknowledges that he,she or it holds Ind`idual
and non-transfe responsibility fo 1e y,to and complying with the ESA. The Applicant has read this disclaimer and signs and dates below.
Signature: AL."... € �O:T7 Da eg. 7,c//Y ':±'.
r
G:\Penn ter\###FORMS###\DRD Fr.'RMS\Master Permit Application 5-29-08.doc
1
•
BUILDER STATEMENT i'
The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contracto='end that
they will be assuming sponsibi ity of the General Contractor for the proposed project.L� L f
Signature: Date: ti 1
M r J V r r-
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: v, C I NY L�
MAILING ADDRESS: EMAIL: 'K' 1I11'!
CONTRACTOR'S LICENSE WAINS
I 6 i ,
NUMBER: NUMBER I '/11 aly
ARCHITECT/ENGINEER: PHONE ( ) L
MAILING ADDRESS: EMAIL fFPT I OMMUNIIY DEVE =MI
Project Type: Frame Type: Bathrooms: Shorelin-. ype o Sewage Displ..'-al:
0 New ❑ Wood Existing:. ❑ Sewer ,
0 Addition 0 Steel Proposed: Bank ❑ Community y System
• Alteration/Remodel 0 Concrete Total: Height:
O Repair 0 Masonry SEP Permit#
O Demolition 0 Other: Bedrooms: Water Supply:
Existing: Setback: 0 Private well 0 Tyr o Party
Type of Heat Proposed: 0 Public
Total: Name of System: ,..,
If this is a Commercial Protect you must answer the following:
Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces:__
Number of occupants(includes owners,tenants,employees,etc) Current Proposed
IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No
if this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: 1
1 Underground Tank Above ground-rank) Size of Propane Tank: I. 1
1 Heat Stove I Cook Stove 1 Woodstove Fire lace Inserter 1 Hot Water Tank 1 Pellet Stove 1 Other Z�
Is this appliance being installed in a Manufactured/Mobile Home? Yes / No li
When applying for permit to install a propane tank you must also submit a site plan showing all of the buildings,all properly
lines,tank location and size,distances from the propane tank to all property lines,buildings and septic system components,
including the reserve area. -
m
,�,hu v"nEl��x+�.,'i3 ? r. q i a,er _ ,r �t ',1 viF yr A,9 }
S•uare Foote!e Current Pro posed ` �f"' Iv 'a i<'.„Illr�r :..� s:. �; 1 ' , �� li 111 .., � 1 ,; r,• ts e.l. I
Main Floor Heated :1 ,t t,. ,' EH Bid App Review:
.1 �r
t °,t t ',
2"0 Floor Heated , ' Consistency Review: ,,
Other Heated '''a,' ;
Parcel Details Page 1 of 2
•
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Home County Info
Departments Scorch
Parcel Number: 935100010 SEARCH
Parcel Number: 935100010 Printer Friendly
Owner Mailing Address:
GARY GRIFFITH
13149 SAN ANTONIO AVE
CHINO CA91710-6905
Site Address:
821 THORNDYKE RD
PORT LUDLOW 98365
Section: 9 School District:Chimacum (49)
Qtr Section: SW1/4 Fire Dist: Port Ludlow (3)
Township: 27N Tax Status: Taxable
Range: 1E Tax Code: 0231
Planning area: Paradise Bay (8)
Sub Division: 9351 - BRIDGEHAVEN DIV. 5
Assessor's Land Use Code: 1100 - Residential - Single Unit
Property Description:
BRIDGEHAVEN DIV 5 LOT 11
Tax,A/V, Sales, Photos,and
Permit Data Bido Data Map Parcel Plats&Surve is
Septic Monitoring Info
4 4,4; Jefferson County HOME I COUNTY INFO I DEPARTMENTS I SEARCH
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http://www.co.jefferson.wa.us/assessors/parcel/parceldetail.asp?Parcel NO 935100010 7/14/2014
��go,soN co G JEFFERSON COUN� •
2` DEPARTMENT OF COMMUNITY DEVELOPMENT
Sti f N G.C3
Date: Time Received: //:di<S am/pm Mon Tue. Wed. Thur. Fri.
Date: 9/iss/i t
BLD: 1 't 143 Contact Name:
Owner: Contact Number: 360 395 - S7Q7
Address: 8 -( �-toglODYIt.e 206
Notes: 66-MFeA-rOZ * 6A s Pt?1xrG
Foundation Plumbing Framing Propane Tank Mechanical
Setbacks Under-ground Framing Under ground Furance
Footing Rough In Air Seal Above ground Gas
Stemwall Hydronic Exterior shear Exterior lines Oil
Straps Hot Water Htr Interior shear Interior lines Ducts
Post Hole Ventilation Appliance
Underfloor Gas/Wood stove
Man-Homes Insulation
Final Inspection
Setbacks Floor
Foundation Wall Address Posted
Block&Tile Ceiling
F��SO\ COG JEFFERSON COUNT
•
w
DEPARTMENT OF COMMUNITY DEVELOPMENT
9yxf*7G._O/
Date: a//1/ Time Received: Z y Z ' a Mon. Tue. Wed. Thur. Fr9
/ Date: a- 15
BLD: 1 't Oe,Z 43 Contact Name:
Owner: GQwivit`g Contact Number: 360 3e5 574'7
Address: au -itbevoYK6 206
Notes:
Foundation Plumbing Framing Propane Tan Mechanical
Setbacks Under-ground Framing Under ground )4', Furance
Footing Rough In Air Seal Above ground Gas
Stemwall Hydronic Exterior shear Exterior lines Oil
Straps Hot Water Htr Interior shear Interior lines • Ducts
Post Hole Ventilation �p�p��z Appliance
Underfloor j. E Gas/Wood stove
Man-Homes Insulation
Final Inspection
Setbacks Floor
Foundation Wall Address Posted
Block&Tile Ceiling
•
MECHANICAL AND DEMOLITION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT#: BLD14-00243 Received Date 7/14/2014
SITE ADDRESS: 821 THORNDYKE RD Issue Date 7/15/2014
PORT LUDLOW, 98365
APPLICANT: GARY GRIFFITH PHONE: 360-344-2300
13149 SAN ANTONIO AVE
CHINO CA 91710-6905
11
SUBDIVISION: 9351 Block: Lot:
PARCEL NUMBER: 935100010 Section: 9 Township: 27N Range: 1E
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339 ((33 � 3g5
Contractor's License SUNSHP*077QP Expires 1'f/167/�014-5875
OWNER, GARY GRIFFITH PHONE: 360-344-2300
if different: 13149 SAN ANTONIO AVE
CHINO CA 91710-6905
PROJECT DESCRIPTION: NEW PROPANE TANK 120 gallon
Directions For Fireplace Insert & Zero clearance fire place
To Site: 4.66 ).6rArotz.
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 7/15/2015.
REQUIRED INSPECTIONS: ,r
Installation per Manufacturer Specifications/CO2: 4045 6I P1#4 t'& 44� r�
Tank/Line/Appliance: '/LO --(AVJgS Q®•<' 8I/S// S-x—r-A '.IOA 1 pi oz. L / 8//51/1
Final Approval: '—[SI t
BUILDING INSPECTION HOT-LINE 379-4455.
REQUESTS MUST BE RECEIVED BY 3 PM THE DAY BEFORE THE INSPECTION IS NEEDED.
Office Hours 9:00 a.m. -4:30 p.m. Monday-Thursday
HOT LINE AVAILABLE 24 HOURS A DAY
\\tidemark\data\forms\F_BLD_Permit_Propane.rpt 7/15/2014
• •
MECHANICAL AND DEMOLITION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT#: BLD14-00243 Received Date 7/14/2014
SITE ADDRESS: 821 THORNDYKE RD Issue Date 7/14/2014
PORT LUDLOW, 98365
APPLICANT: GARY GRIFFITH PHONE: 360-344-2300
13149 SAN ANTONIO AVE
CHINO CA 91710-6905
11
SUBDIVISION: 9351 Block: Lot:
PARCEL NUMBER: 935100010 Section: 9 Township: 27N Range: 1E
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339 ((gg
Contractor's License SUNSHP*077QP Expires 11'/160 0-5875
OWNER, GARY GRIFFITH PHONE: 360-344-2300
if different: 13149 SAN ANTONIO AVE
CHINO CA 91710-6905
PROJECT DESCRIPTION: NEW PROPANE TANK 120 gallon
Directions For Fireplace Insert
To Site:
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 7/14/2015.
REQUIRED INSPECTIONS:
Installation per Manufacturer Specifications/CO2:
Tank/Line/Appliance:
Final Approval:
BUILDING INSPECTION HOT-LINE 379-4455.
REQUESTS MUST BE RECEIVED BY 3 PM THE DAY BEFORE THE INSPECTION IS NEEDED.
Office Hours 9:00 a.m. -4:30 p.m. Monday-Thursday
HOT LINE AVAILABLE 24 HOURS A DAY
\\tidemark\data\forms\F_BLD_Permit_Propane.rpt 7/14/2014
Dc_D
JEFFERSON couNi• No1 4 8 8 8 0
DATE 07/14P0I+
AMOUNT
Sanlifte BARS*
&Job FZ 6
- , "
07)
RECEIVED FROM
CURRENCY 13
CU
DESCRIPTION
CAA' / el.
, .A'',=';'''■ ''': COIN
at?
--I
m
23
.ef .‘ itlY
- i !.•,, .,•:,.:,./•..-, , ,„1 i 0 0
• m
,, 1 ' 9,4°,.;?:' V ' eri WI 61-4")
,
...c
Pf..,-W r I 'i-m°';;;, / 0
;$11:
OD
24 il
TOTAL
t
RECEIVED BY _Pj14)_2,h,,ae121n4-)