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HomeMy WebLinkAboutBLD2000-00494 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 #: BLD00-00494 Received Date 7/28/2000 SITE ADDRESS: 220 SHINE RD Issue Date 7/28/2000 PORT LUDLOW, 98365 Expiration Date 7/28/2001 APPLICANT: DON L SANTY PHONE: 220 SHINE RD PORT LUDLOW WA 98365 4/3 SUBDIVISION: R SHAW SHORT PLAT Block: Lot: PARCEL NUMBER: 821333023 Section: 33 Township: 28N Range: 01 E 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 GAS LINE INSTALLATION (RELOCATION) 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 07/28/2001. REQUIRED INSPECTIONS: [ ] Tank/Line/Applies f�q/17//( v/ ( /A(e 0(e-- T�(id:Dp ,. [ ] FinalApproval: 'A/el-/ d/(-" IV( 4© Q _ ilfV 7 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 #: BLD00-00494 Received Date: 7/28/2000 SITE ADDRESS: 220 SHINE RD PORT LUDLOW, 98365 APPLICANT: DON L SANTY PHONE: 220 SHINE RD PORT LUDLOW WA 98365 SUBDIVISION: R SHAW SHORT PLAT Block: Lot: 4/3 PARCEL NUMBER: 821333023 Section: 33 Township: 28 N Range: 01 E CONTRACTOR: GAS CONNECTION PHONE: (360)479-0105 1809 SHOREWOOD DR BREMERTON WA 98312 Contractor's License GASCO**082P6 Expires 10/12/2000 ARCH ITECT/ ENGINEER : PROJECT DESCRIPTION: PROPANE GAS LINE INSTALLATION (RELOCATION) 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: SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: 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 Type Amount Paid By: Date: �rReceipt - Plat ea/u Approved/Pate Receipt: pp d/date Propane Tanks/Stoves $48.00 MAM 07/28/00 33367 Total: $48.00 is\F_BLD_App_Bld.rpt 10/29/99 0 M , JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 PH: 13601 379-4450 INSTALLATION PERMIT APPLICATION WOODSTOVE PROPA1 TANK V PELLET STOVE OTHER SITE ADDRESS: 911#/ROAD NAME 2 2Z) ,.0 � �[)(� /,, ,, t�� ,t__- ZIP 7:5J2 6. 9 DIGIT PARCEL ID NUMBER 2-/ 'T35 0 G-) Legal Description: Subdivision Name Block Lot(s) Section 363 Township ;28 it) North, Range / WM APPLICANT C'f/L�iL C{ ��LL PHONE .779-��( MAILING ADDRESS _� ,;( ///O ‘,,,,,,,,,,,,,,,,,L.,- ZIP ��3y 7_,...- PROPERTY OWNER .Por,t2 ,5 j1]7f PHONE 4'3 7 9747 MAILING ADDRESS ,ZP-e) L - /2.0 Ce»rgA-6T V ‘-'f' df-at/Z/,------- ZIP ,5�'� CONTRACTOR 4-24. PHONE 7 79 -- 9,84- MAILING ADDRESS `. " //�/D SC ?(T'� l5,r�// ZIP 9,3' STATE LICENSE# (,.L7,‘,/7 0- /9 J J/9 EXP. DATE ..,3 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 104.-/ DATE 7 i i /1'V� 4*-9 FOR OFFICE USE ONLY BASE FEE RECEIPT# T333( CASH/CK# L..S C)' TOTAL DATE - lit,4 l co H:\HOME\PLNCNTR\FORMS\IN STALL.DO C 10/99