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HomeMy WebLinkAboutBLD2000-00035 F , 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 (800)831-2678 PERMIT #: BLD00-00035 Received Date 1/13/2000 SITE ADDRESS: 301 S KEEL WAY Issue Date 1/13/2000 PORT LUDLOW, 98365 Expiration Date 1/13/2001 APPLICANT: JIM ULM PHONE: 301 S KEEL PORT LUDLOW WA 98365 SUBDIVISION: LUDLOW POINT VILL Block: 2 Lot: 3 PARCEL NUMBER: 969500003 Section: 17 Township: 28 N Range: 01 E CONTRACTOR: FERRELLGAS PHONE: (360)385-6998 2108 SIMS WAY PORT TOWSEND WA 98368 Contractor's License FERRELP055LH Expires 8/1/00 OWNER, if different: PROJECT DESCRIPTION PROPANE TANK, GAS LINE & RANGE 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 1/13/01. REQUIRED INSPECTIONS: [ ] Tank/Line/Appliance: FinalApproval: VIA 3 _13 ® © Q7� f s BUILDING PERMIT APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD00-00035 Received Date: 1/13/2000 SITE ADDRESS: 301 S KEEL WAY PORT LUDLOW, 98365 APPLICANT: JIM ULM PHONE: 301 S KEEL PORT LUDLOW WA 98365 SUBDIVISION: LUDLOW POINT VILL Block: 2 Lot: 3 PARCEL NUMBER: 969500003 Section: 17 Township: 28 N Range: 01 E CONTRACTOR: FERRELLGAS PHONE: (360)385-6998 2108 SIMS WAY PORT TOWSEND WA 98368 Contractor's License FERRELP055LH Expires 8/1/00 ARCHITECT/ ENGINEER : PROJECT DESCRIPTION: PROPANE TANK, GAS LINE & RANGE INSTALLATION TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION CODE EDITION: ADM.: HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: STORMWATER: YES NO AREA BEDROOMS: BATHROOMS: Wetland Erosion Exist: Exist: Seismic Streams Prop: Prop: Flooding Landslide Total: Total: F&W Plat Conditions Routing Date: Shoreline Aquifer Forest: Commercial Rural Proximity Type Amount Paid By: Date: Receipt: Approved/Date Permit $46.00 MAM 01/13/00 23991 Total: $46.00 I:\F_BLD_App_Bld.rpt 10/29/99 ij�liyl� r 1 , JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 PH: (3601 379-4450 INSTALLATION PERMIT APPLICATION WOODSTOVE PROPANE TANK PELLET STOVE OTHER �j�� , 2 F d''s SITE ADDRESS: 911#/ROAD NAME `3 O/ Pei T f'd I0�- ZIP 9P -1 9 DIGIT PARCEL ID NUMBER %6 9— Se)0-^ 0o 3 Legal Description: Subdivision Name Block Lot(s) Section Township North, Range WM APPLICANT C (L� G� S PHONE I1'f -- 6 j¢d) MAILING ADDRESS ,2/ p 1 S kv,i- ZIP 4?,/{1 PROPERTY OWNER 77M I"i&/Y? PHONE MAILING ADDRESS 3 / S, c"61 L/ ZIP CONTRACTOR Ff1 Z (�-fS PHONE 7/.1—d fb MAILING ADDRESS c?/6/ Si A. PPa1- IV tvivski✓d ZIP 9f 36i/ STATE LICENSE# 6 D / S ') S4 2 EXP. DATE 9 ;.7f '-ADO FEDERAL I.D. # ! 2 1 -L. eo s_.c Z 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 /� J ° L^` DATE ( / /2 / U FOR OFFICE USE ONLY ,` ' BASE FEE RECEIPT# { , EC L l ; t /CK# TOTAL % 6I 0 DP / H:\HOME\PLN C NTR\FORMS\I N STA LL.D0 C 10/99 JEFFERSON COUNTY DEPT.OF COMMUNITY DEVELOPMENT