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HomeMy WebLinkAboutBLD2000-00357 ♦ t 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 #: BLD00-00357 Received Date 6/6/2000 SITE ADDRESS: 15 SEA BREEZE LN Issue Date 6/6/2000 PORT LUDLOW, 98365 Expiration Date 6/6/2001 APPLICANT: M J FONTAINE PHONE: (360)437-7556 15 SEA BREEZE LANE PORT LUDLOW WA 98365 20 SUBDIVISION: TEAL LAKE VILLAGE Block: Lot: PARCEL NUMBER: 998700020 Section: 21 Township: 28N Range: 01E CONTRACTOR: GAS CONNECTION PHONE: (360)479-0105 1809 SHOREWOOD DR BREMERTON WA 98312 Contractor's License GASCO**082P6 Expires 10/12/2000 OWNER, if different: PROJECT DESCRIPTION PROPANE TANK& LOG SET 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 06/06/2001. REQUIRED INSPECTIONS: 44 Tank/Line/Appliance: L FinalApproval: 07- ( C( 00A7/1 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 1 PERMIT #: BLD00-00357 Received Date: 6/6/2000 SITE ADDRESS: 15 SEA BREEZE LN PORT LUDLOW, 98365 APPLICANT: VILLAGE HOMES PHONE: 14410 BELL-RED RD BELLEVUE WA 98007 SUBDIVISION: TEAL LAKE VILLAGE Block: Lot: 20 PARCEL NUMBER: 998700020 Section: 21 Township: 28 N Range: 01 E CONTRACTOR: ALL SEASON GAS PHONE: (360)479-0105 PO BOX 2069 BELFAIR WA 98528 Contractor's License GASCO**082P6 Expires 10/12/2000 ARCHITECT/ ENGINEER : PROJECT DESCRIPTION: PROPANE TANK & LOG SET TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION MAIN: CODE EDITION: ADD'L: HEAT TYPE: PRO OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: PARCEL TAGS: YES NO BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA Exist: Exist: Wetland Erosion Prop: Prop: Seismic Streams Total: Total: Flood Way Flood Plane Routing Date: F&W Landslide Shoreline Aquifer Forest: Commercial Rural I-'r ximit - flat U ditions Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $48.00 LMB 06/06/00 31615 Total: $48.00 _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 SITEADDRESS:9 11#/ROAD NAME ZIP 9r361/4.5--- 9 DIGIT PARCEL ID NUMBER4rr7©©19� Legal Description: Subdivision Name � „ Block Lot(s) Section Township North, Range WPM APPLICANT , PHONE 137"- 7�V MAILING ADDRESS WA/ , , ZIP y�{ PROPERTY OWNER Q ��J PHONE MAILING ADDRESS G— `�- C- O t.0 4L-i3 C ] ZIP CONTRACTOR G PHONE‘? 0 - y.?? (y/O MAILING ADDRESS �yt. Cr"x� ZIP 9er3/ 02 STATE LICENSE # �I4 S C cv ' • d 8'a�A EXP. DATE / C9 —/c . d® FEDERAL I.D. # Tit►t i - S&T �j � 'I LLc,Ein$01, 6 5 • By signing the application form, the applicant/owner attests that the ir(formation 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 attorneys 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 S—/(O / Q QI FOR OFFICE USE ONLY BASE FEE [ RECEIPT# 1(c I CASH/CK# Z. 01) TOTAL DATE / / H:\HOME\PLN CNTR\FORMS\INSTALL.DOC 10/99