HomeMy WebLinkAboutBLD2001-00438 � 3
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 #: BLD01-00438 Received Date 8/2/2001
SITE ADDRESS: 560 JEFFERSON AVE Issue Date 8/2/2001
PORT LUDLOW, 98365 Expiration Date 8/2/2002
APPLICANT: RUSSELL J HENRY PHONE: (360)437-2250
560 JEFFERSON AVE
PORT LUDLOW WA 98365
SUBDIVISION: KELLEN SHORT PLAT 1.31AC Block: Lot:
PARCEL NUMBER: 978900134 Section: 4 Township: 28N Range: 01 E
CONTRACTOR: MOUNTAIN PROPANE LLC PHONE:
265 CHIMACUM RD
PORT HADLOCK WA 98339
OWNER, RUSSELL J HENRY PHONE: (360)437-2250
if different: 560 JEFFERSON AVE
PORT LUDLOW WA 98365
PROJECT DESCRIPTION PROPANE TANK AND LINES
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 08/02/2002.
REQUIRED INSPECTIONS:
[ ] Ta tine/Appliance: Q � � �
[ ] FinalApproval: if/ {
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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.
HOT LINE AVAILABLE 24 HOURS A DAY
is\F_BLD_Permit_Propane.rpt 10/29/19
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SEP90-00627
BUILDING PERMIT APPLICATION Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD01-00438 Received Date: 8/2/2001
SITE ADDRESS: 560 JEFFERSON AVE
PORT LUDLOW, 98365
OWNER: RUSSELL J HENRY PHONE: (360)437-2250
560 JEFFERSON AVE
PORT LUDLOW WA 98365
SUBDIVISION: KELLEN SHORT PLAT 1.31AC Block: Lot:
PARCEL NUMBER: 978900134 Section: 4 Township: 28 N Range: 01 E
CONTRACTOR: MOUNTAIN PROPANE LLC PHONE:
265 CHIMACUM RD
PORT HADLOCK WA 98339
REPRESENTATIVE(S): LLOYD RAWLINGS
560 JEFFERSON DR
PORT LUDLOW WA 98365
PROJECT DESCRIPTIO PROPANE TANK AND LINES
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW
VALUATION MAIN:
CODE EDITION: 1997 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: PARCEL TAGS: YES NO
BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA
Exist: Exist: Wetland Erosion
Prop: Prop: Seismic Streams
Total: Total: Flood Way Floodplain
F&W Landslide
Routing Date:
Shoreline Aquifer
Forest: Commercial Rural
Proximity Plat Conditions
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 PRB 08/02/01 29290
Total: $48.00
JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSEND WA 9836$ PH: (3601 379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE X PROPANE TANK PELLET STOVE OTHER
SITE ADDRESS: /� _
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9 DIGIT PARCEL ID NUMBER 6 E� O OO /3 2/
Legal Description: I
Subdivision Name I''LZL6--V Si- OI T PLAT -OT Block Lot(s)
Section Township North, Range WM
APPLICANT ?U J 73L2C V C- 1 p y PHONE (36 0') /13 7- .�5 C)
MAILING ADDRESS / 3 66 x .72 O
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CONTRACTOR MOo,v 7440 PgCofV/1 PHONE `3d0 - 3
MAILING ADDRESS (� J�J7yj,4 C a44 Rt ,
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STATE LICENSE# 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.
ridAPPLICANT SIGNATURE ,gyp/C DATE 0 / Q Co 1
FOR OFFICE USE ONLY
BASE FEE U " RECEIPT# gq V t.
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TOTAL DATE 2I/
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