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HomeMy WebLinkAboutBLD2000-00178 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 #: BLD00-00178 Received Date 3/22/2000 SITE ADDRESS: 470 TALA SHORE DR Issue Date 3/22/2000 PORT LUDLOW, 98365 Expiration Date 3/22/2001 APPLICANT: CLIFF ELBERT PHONE: 470 TALA SHORE DR PORT LUDLOW WA 98365 SUBDIVISION: TALA SHORES#3 13 Block: 3 Lot: PARCEL NUMBER: 998200313 Section: 15 Township: 28N Range: 01 E CONTRACTOR: NORTHWEST FIREPLACE -- STD'JE PHONE: (360)385-1420 4207 WHEATON WAY SUITE A BREMERTON WA 98310 Contractor's License PETTIOCO88CC Expires 05/01/2000 OWNER, I'ETTI T - TAN K if different: PROJECT DESCRIPTION PROPANE TANK& STOVE 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 03/22/2001 REQUIRED INSPECTIONS: [ ] Tank/Line/Appliance: fit 3r 23, O© /34 z 1 ] Fi nalApproval: , ,� "3[ C 7C) , 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 #: BLD00-00178 Received Date: 3/22/2000 SITE ADDRESS: 470 TALA SHORE DR PORT LUDLOW, 98365 APPLICANT: CLIFF ELBERT 470 TALA SHORE DR PHONE: PORT LUDLOW WA 98365 SUBDIVISION: TALA SHORES#3 Block: 3 PARCEL NUMBER: 998200313 Section: 15 Township: 28 N Range: 01 E t: 13 CONTRACTOR: NORTHWEST FIREPLACE 5TOVF PHONE: (360)385-1420 4207 WHEATON WAY SUITE A BREMERTON WA 98310 Contractor's License PETTIOCO88CC Expires 05/01/2000 ARCHITECT/ PETTI ENGINEER : - TAM K PROJECT DESCRIPTION: PROPANE TANK & STOVE INSTALLATION TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION MAIN: CODE EDITION: ADD'L: HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: CONST TYPE: OTHER: CONST TYPE: GARAGE: SHORELINE: DECK: SETBACK: SEWAGE DISPOSAL: BANK HEIGHT: 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 Propane Tanks/Stoves $48.00 MAM 03/22/00 27075 Total: $48.00 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 --{- v SITE ADDRESS: 911#/ROAD NAME 1/70 J-L/5t i���/�'� 0/C1/// � v 0 LLB f) t-L- d4 ZIP 9 DIGIT PARCEL ID NUMBER Cjc W - 1 '2) Legal Description: Subdivision Name Block Lot(s) Section Township North, Range WM APPLICANT PHONE MAILING ADDRESS ZIP PROPERTY OWNER eA (,C ,t-d% 4=L6e- PHONE 92 MAILING ADDRESS -/YO 7 , L-At Q /,') C ..�62Z)Z Ot'1 ) uJ�- ZIP 7 b a d CONTRACTOR PHONE MAILING ADDRESS nl/90127//e2C,e5 / j%/'i@C /`� CJt'1 et ZIP STATE LICENSE # /7?,(2L�,7'7 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 / / FOR OFFICE USE ONLY BASEFEE - ' RECEIPT# 5 CASH/CK# 1,0 1 TOTAL DATE ,3 /22l co H:\HOME\PLNCNTR\FORMS\INSTALL.DOC7 0/99