HomeMy WebLinkAboutBLD2002-00056 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 #: BLD02-00056 Received Date 2/6/2002
SITE ADDRESS: 140 TALA SHORE DR Issue Date 2/6/2002
PORT LUDLOW, 98365 Expiration Date 2/6/2003
APPLICANT: DANIEL E PETRENCHAK PHONE:
140 TALA SHORE DR
PORT LUDLOW WA 983659259
SUBDIVISION: TALA SHORES#1 Block: Lot:
PARCEL NUMBER: 998200125 Section: 22 Township: 28N Range: 01 E
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 9/6/02
OWNER, DANIEL E PETRENCHAK PHONE:
if different: 140 TALA SHORE DR
PORT LUDLOW WA 983659259
PROJECT DESCRIPTION NO MLA RQRD--PROPANE TANK ONLY
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 2/6/03.
REQUIRED INSPECTIONS:
[ 0, Line/Appliance: f(-7 -5-17"ez
[ ] FinalApproval: r--
BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS.
Office Hours 9:00 a.m. -4:30 p.m.
HOT LINE AVAILABLE 24 HOURS A DAY
is\F_BLD_Perm it_Propane.rpt 10/29/99
BUILDING PERMIT APPLICATION Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00056 Received Date: 2/6/2002
SITE ADDRESS: 140 TALA SHORE DR
PORT LUDLOW, 98365
OWNER: DANIEL E PETRENCHAK PHONE:
140 TALA SHORE DR
PORT LUDLOW WA 983659259
SUBDIVISION: TALA SHORES#1 Block: Lot:
PARCEL NUMBER: 998200125 Section: 22 Township: 28 N Range: 01 E
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 9/6/02
REPRESENTATIVE(S):
PROJECT DESCRIPTIO NO MLA RQRD--PROPANE TANK ONLY
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:
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 Floodplain
Routing Date: F&W Landslide
Shoreline Aquifer
Forest: Commercial Rural
Proximity Plat Conditions
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 PRB 02/05/02 45651
Total: $48.00
JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNSEND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE �' PROPANE TANK PELLET STOVE OTHER
Is this appliance(htg stove, hot water tank,furnace, etc.)to be installed in a Manufactured/Mobile Home
YES / NO
SITE ADDRESS(91111##/Road Name):
/ Y/R ��` S ae
1/-74/.t 7- ` // /U /A) ZIP ?Vf45
9 DIGIT PARCEL ID NUMBER 12$7--00 (2e
Legal Description:
Subdivision Name Block Lot(s)
Section ��}^'' �Toownshipp North, Range �f Q�Q� WM
APPLICANT .' /41 t' / ,/-E' L ,VA K PHONE , �P�U V 7
MAILING ADDRESS 7W :4/ /4 �, a 2>/'p ,
''', }} 4 L�!- mi4 ZIP u‘4-
PROPERTY OWNER 0`/:(" .i /! / % // /� PHONE / LJ , er-7
MAILING ADDRESS_ GJ 7 k 4 -.c CI'- l�/2
61 /j ,'ji l , 6, ZIP 7 s'i 6--
CONTRACTOR (. L am ' PHONE 7.c2 - J p
MAILING ADDRESS,00/;" ' / . I ff:
/)� Ze--• /Liy / ZIP ,El c
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.
APPLICANT SIGNATURE DATE / ,J / 44�
(:&--.....,
FOR OFFICE USE ONLY ��f
ff.,...- .._---
BASE FEE RECEIPT# �T �J b1
CASH/CK# CAS*
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TOTAL ''�/ DATE � l 0---
H:\HOME\PLNCNTR\INFOBLDG\FORMS\INSTALL.DOC 11/05/01