HomeMy WebLinkAboutBLD2002-00089 Y
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 #: BLD02-00089 Received Date 2/20/2002
SITE ADDRESS: 231 BELFRAGE RD Issue Date 2/20/2002
PORT LUDLOW, 98365 Expiration Date 2/20/2003
APPLICANT: HANS D VODDER JR PHONE:
231 BELFRAGE RD
PORT LUDLOW WA 983658763
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 821183007 Section: 18 Township: 28N Range: 01 E
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPL994BH Expires 12/14/2002
OWNER, HANS D VODDER JR PHONE:
if different: 231 BELFRAGE RD
PORT LUDLOW WA 983658763
PROJECT DESCRIPTION PROPANE TANK, HEAT STOVE AND GAS LINE
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 02/20/2003.
REQUIRED INSPECTIONS:
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[ ] i nalApproval-) �,e 4} 0 /'// ' '
BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTION
Office Hours 9:00 a.m. -4:30 p.m.
HOT LINE AVAILABLE 24 HOURS A DAY
is\F_BLD_Permit_Propane.rpt 10/29/19
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BUILDING PERMIT APPLICATION Revie Type:
Review 9
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00089 Received Date: 2/20/2002
SITE ADDRESS: 231 BELFRAGE RD
PORT LUDLOW, 98365
OWNER: HANS D VODDER JR PHONE:
231 BELFRAGE RD
PORT LUDLOW WA 983658763
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 821183007 Section: 18 Township: 28 N Range: 01 E
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPL994BH Expires 12/14/2002
REPRESENTATIVE(S):
PROJECT DESCRIPTIO PROPANE TANK, HEAT STOVE AND GAS PIPE
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 Floodplain
F&W Landslide
Routing Date: z/ 47
Shoreline Aquifer
Z� Forest: Commercial Rural
Proximity Plat Condition-
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 ZAN 02/20/02 45646
Total: $48.00
•
JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNSEND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE �ROPANE TANK PELLET STOVE OTHER /-7ii?Al "---S i�6/C°' 'GCS- 1
Is this appliance (htg stove, hot water tank,furnace,etc.)to be installed in a Manufactured/Mobile Home?
YES . NO
SITE ADDRESS(911#/Road Name):
P-s-3/ ,427 4u( `% �:
Q/ f G�G(`/DvG� (�'1✓1 ZIP
9 DIGIT PARCEL ID NUMBER ')/)'' / / 3 od 2
Legal Description: /� .
Subdivision Name /G\X / Block Lot(s)
Section Township North, Range WM
APPLICANT ��;° /�, / /� ��
l iil1 ,'� ij l/ :, ram%/� \ PHONE /� , -S
MAILING ADDRESS ?
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PROPERTY OWNER ��il .( PHONE
MAILING ADDRESS
ZIP
CONTRACTOR PHONE
MAILING ADDRESS
ZIP
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.
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APPLICANT SIGNATURE ,/ ".�''lit."-- /
,/� A: ., DATE / l / (fiO,G
/ �h l /-FOR OFFICE USE ONLY
BASE FEE LtO i W RECEIPT# q �!J c(b
(} CASH/CK# �l 6 6
TOTAL lib ( DATE 2/ ! 0
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H:W OME\PLNCNTR\INFOBLDG\FORMS\INSTALL.DOC 11/05/01