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HomeMy WebLinkAboutBLD2000-00059 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 #: BLD00-00059 Received Date 1/24/2000 SITE ADDRESS: 174 LAGOON LN Issue Date 1/24/2000 PORT LUDLOW, 98365 Expiration Date 1/24/2001 APPLICANT: RENE ST. ONGE PHONE: (360)437-2142 174 LAGOON LANE PORT LUDLOW WA 98355 SUBDIVISION: LUDLOW BEACH TRS 1 Block: Lot: PARCEL NUMBER: 968700106 Section: 16 Township: 28N Range: 01 E CONTRACTOR: CENEX SUPPLY & MARKETING PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CENEXHS022NQ Expires 06/01/2000 OWNER, if different: PROJECT DESCRIPTION PROPANE TANK 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 01/24/2001. REQUIRED INSPECTIONS: [ ] Tank/Line/Appliance: [ ] FinalApproval: BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS. Office Hours 9:00 a.m. -4:30 p.m. Inspector's Phone Hours 8:00 a.m. - 9:00 a.m. SPECIAL CONDITIONS MAY APPLY - SEE REVERSE HOT LINE AVAILABLE 24 HOURS A DAY BUILDING PERMIT`APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD00-00059 Received Date: 1/24/2000 SITE ADDRESS: 174 LAGOON LN PORT LUDLOW, 98365 APPLICANT: RENE ST. ONGE PHONE: (360)437-2142 174 LAGOON LANE PORT LUDLOW WA 98355 SUBDIVISION: LUDLOW BEACH TRS 1 Block: Lot: PARCEL NUMBER: 968700106 Section: 16 Township: 28 N Range: 01 E CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CENEXHS022NQ Expires 06/01/2000 ARCH ITECT/ ENGINEER : PROJECT DESCRIPTION: PROPANE TANK INSTALLATION TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION MAIN: CODE EDITION: ADDT: HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: # OF STORIES: OTHER: CONST TYPE: GARAGE SHORELINE: CONST TYPE: DECK: SETBACK: 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 01/24/00 24029 Total: $46.00 I:\F_BLD_App_Bld.rpt 10/29/99 JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 PH: (360) 379-4450 INSTALLATION PERMIT APPLICATION WOODSTOVE PROPANE TANK PELLET STOVE OTHER SITE ADDRESS: / /``_ 911#/ROAD NAME / /'/ /fie'Z Jo vi � ZIP 9 DIGIT PARCEL ID NUMBER (0g CO (O jr^t 0 `/ (� % Legal Description: Subdivision Name - Block Lot(s) Section Township North, Range WM APPLICANT PHONE MAILING ADDRESS c / 4r c>1:1 ZIP PROPERTY OWNER Re- -l7UE?/ t ! �i, ©�!�_� PHONE y 7'c./ 9 MAILING ADDRESS , e7 �pp�.. / ���`'- �-� �� c✓ U^,?' ZIP CONTRACTOR f - c/'Lie'< .5.17?,•-eSPH0NE MAILING ADDRESS c7 3 5 Rd Lj --e- ZIP STATE LICENSE # ��E - 3 o eZ EXP. DATE FEDERAL I.D. # 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 DATE / ! /ci FOR OFFICE USE ONLY BASE FEE RECEIPT# "' CASH/CK # TOTAL DATE / / H:\HOME\PLNCNTR\FORMS\INSTALL.DOC 10/99