HomeMy WebLinkAboutBLD2000-00810 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 #: BLD00-00810 Received Date 12/19/2000
SITE ADDRESS: 51 WINDROSE PL Issue Date 12/19/2000
PORT LUDLOW, 98365 Expiration Date 12/19/2001
APPLICANT: CHARLES J MALVEN PHONE:
51 WINDROSE
PORT LUDLOW WA 98365
SUBDIVISION: BAYVIEW VILLAGE DIV 1 Block: Lot:
PARCEL NUMBER: 931900022 Section: 16 Township: 28N Range: 01E
CONTRACTOR: CENEX SUPPLY& MARKETING - T/sP-t - PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518 f2 1- S dln S
Contractor's License RSSALS*022PB Expires 10/01/2001 ST $V
OWNER, CHARLES J MALVEN PHONE:
if different: 51 WINDROSE
PORT LUDLOW WA 98365
PROJECT DESCRIPTION PROPANE TANK & GAS INSERT 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 12/19/2001.
REQUIRED INSPECTIONS:
inepp lance: 1 2' Zf1
[ Ina APprov L% 'lam � ��`�e //"�C�
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
JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 PH: (360) 379-4450
INSTALLA.TION PERMIT APPLICATION
r
WOODSTOVE X/ PROPANE TANK PELLET STOVE OTHER AS , i v/Ce '�
SITE ADDRESS:
911#/ROAD NAME 57 hfA j/I di d se__ i
Pet ` acf o w W A ZIP
9 DIGIT PARCEL ID NUMBER 613 1 - ab 0 p ZZ
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT /I S SAl/S Stith C-e PHONE 379" Sc/ 2 q
MAILING ADDRESS Pi o , $oX 70 3
C L 1 tAAc..c-V\..W, VA ZIP ? g 302
PROPERTY OWNER I t(. L I /V l6(I It.,(..- PHONE
MAILING ADDRESS 5 k/i`cir0 S Q , r
IG''/-4- L t -41-0 LO ` J A ZIP
f� 229-- sy5
CONTRACTOR R.I.( c��A S PHONE 7 '2-17175 t�
MAILING ADDRESS prO �'V° 7C
C, I Vl1 ZIP 7.e. '2
r
STATE LICENSE # L C (� 36 2 s,c 9-L S - 0 z2 Pt EXP. DATE /D`//-20O/
.FEDERAL I.D. # 6 0/ 7dS.-- 2Z/y 00/ � O
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.
4 APPLICANT SIGNATURE L,,Z/ DATE / 1 /f/ e57°
FOR OFFICE USE ONLY
BASE FEE RECEIPT# 73-R-I S 3
- CASH/CK# 1 1+0 CI
TOTAL Lfb DATE la-/ tCl / 00
H:\HOME\PLNCNTR\FORMS\INSTALL.DOC 10/99
BUILDING PERMIT APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD00-00810 Received Date: 12/19/2000
SITE ADDRESS: 51 WINDROSE PL
PORT LUDLOW, 98365
APPLICANT: CHARLES J MALVEN PHONE:
51 WINDROSE
PORT LUDLOW WA 98365
SUBDIVISION: BAYVIEW VILLAGE DIV 1 Block: Lot:
PARCEL NUMBER: 931900022 Section: 16 Township: 28 N Range: 01 E
CONTRACTOR: CENEX SUPPLY & MARKETING — -{-dV\ PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License RSSALS*022PB Expires 10/01/2001
ARCHITECT/
ENGINEER : t(Z.t S Salt_s .,l- ,Se-r V; S
PROJECT DESCRIPTION: PROPANE TANK & GAS INSERT INSTALLATION
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 1997 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: 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
F&W Landslide
Routing Date: Shoreline Aquifer
Forest: Commercial Rural
Proximi
ty - I-'lat Conditions
—
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $46.00 MAM 12/19/00 37153
Total: $46.00
is\F_BLD_App_Bld.rpt 10/29/19