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HomeMy WebLinkAboutBLD2000-00255 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 #: BLD00-00255 Received Date 4/27/2000 SITE ADDRESS: 3851 LARSON LAKE RD Issue Date 5/1/2000 PORT LUDLOW, 98365 Expiration Date 5/1/2001 APPLICANT: KENT DEWITT PHONE: 3851 LARSON LAKE ROAD PORT LUDLOW WA 98365 4 SUBDIVISION: Block: Lot: PARCEL NUMBER: 821073006 Section: 07 Township: 28N Range: 01 E CONTRACTOR: SUBURBAN PROPANE PHONE: 385-5096 P 0 BOX 989 PORT TOWNSEND WA 98368 Contractor's License SUBURPL044DA Expires 03/01/2001 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 05/01/2001. REQUIRED INSPECTIONS: [ Tank/Li /Appliance: [ FinalApproval: (� c565/© O k7.'?d 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 #: BLD00-00255 Received Date: 4/27/2000 SITE ADDRESS: 3851 LARSON LAKE RD PORT LUDLOW, 98365 APPLICANT: KENT DEWITT PHONE: 3851 LARSON LAKE ROAD PORT LUDLOW WA 98365 SUBDIVISION: Block: Lot: 4 PARCEL NUMBER: 821073006 Section: 07 Township: 28 N Range: 01 E CONTRACTOR: SUBURBAN PROPANE PHONE: 385-5096 P 0 BOX 989 PORT TOWNSEND WA 98368 Contractor's License SUBURPL044DA Expires 03/01/2001 ARCH ITECT/ ENGINEER : PROJECT DESCRIPTION: PROPANE TANK 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: 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 Propane Tanks/Stoves $48.00 MAM 04/27/00 27248 Total: $48.00 I:\F_BLD_App_Bld.rpt 10/29/99 Lc ��.. JEFFERSON COUNTY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 PH: (360) 379-4450 /,/' I 'STA LATION PERMIT APPLICATION WOODSTOVE \ P...,ROPANE TANK PELLET STOVE OTHER SITE ADDRESS: 9 911#/ROAD NAME ' t ,� ZAC' PO( �T ) V\ -/ A ZIP 9 DIGIT PARCEL ID NUMBER Ze,A- -' 8-e...) ©?3" 006 Legal Description: Subdivision Name B ck Lot(s) Section Township North, Range WM APPLICANT v 3` PHONE `�-''-' --Qr6' �y MAILING ADDRESS E� " ✓1 �0� 0 ^--C-- V'-' ZIP _� V PROPERTY OWNER 16:5,1./ / ( PHONE 732 77 MAILING ADDRESS 7'-`-'Z1,1,� ZIP CONTRACTOR � � �1/4T- 1 PHONE MAILING ADDRESS � ZIP STATE LICENSE# S t�bQ /7 U Q - `-riO 4 EXP. DATE Q ' 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 t e ap licant's property or structure shall be requested and shall occur during regular business hours. APPLICANT SIGNATURE DATE 4/ / / FOR OFFICE USE ONLY , , ' ca i,i/' CO, BASE FEE RECEIPT# :>t CASH/CK# TOTAL J` DATE i / H:\HOME\PLN CNTR\FORMS\INSTALL.D0 C 10/99