HomeMy WebLinkAboutBLD2002-00129 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 #: BLD02-00129 Received Date 3/11/2002
SITE ADDRESS: 343 CAMBER DR Issue Date 3/11/2002
PORT LUDLOW, 98365
APPLICANT: KEITH J BROWN TRUSTEE PHONE:
MARGARET N BROWN TRUSTEE
343 CAMBER LN
PORT LUDLOW WA 983659579 19
SUBDIVISION: LUDLOW POINT VILLAGE DIV 3 Block: Lot:
PARCEL NUMBER: 969700019 Section: 17 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 09/06/2002
OWNER, KEITH J BROWN TRUSTEE PHONE:
if different: MARGARET N BROWN TRUSTEE
343 CAMBER LN
PORT LUDLOW WA 983659579
PROJECT DESCRIPTION PROPANE TANK 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 03/11/2003.
REQUIRED INSPECTIONS:
L Tan -Line/Appliance l �. /2-74 27A
Fi nalApp a1? i/7 c'/sc' z: -'zr? .�e
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_Permit_Propane.rpt 10/29/19
BUILDING PERMIT APPLICATION BLD02-00129
Review Type: `
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00129 Received Date: 3/11/2002
SITE ADDRESS: 343 CAMBER DR
PORT LUDLOW, 98365
OWNER: KEITH J BROWN TRUSTEE PHONE:
MARGARET N BROWN TRUSTEE
343 CAMBER LN
PORT LUDLOW WA 983659579
SUBDIVISION: LUDLOW POINT VILLAGE DIV 3 Block: Lot: 19
PARCEL NUMBER: 969700019 Section: 17 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 09/06/2002
REPRESENTATIVE(S):
PROJECT DESCRIPTIO PROPANE TANK 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 Floodplain
Routing Date: _, F&W Landslide
/ Shoreline Aquifer
� / l Forest: Commercial Rural
Proximity Plat Condition:,
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 ZAN 03/11/02 45791
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(911#/Road Name):
L_vt L,G7 Uv u-)fr' ZIP I b S
9 DIGIT PARCEL ID NUMBER c b 9 - 7 0 o f 9
Legal Description:
Subdivision Name Block Lot(s)
Section .l Township North, Range WM
APPLICANT � z IT�I- p712-6 CO PHONE
MAILING ADDRESS 34 (4 `G->Z- I--N./
/
?()12� L-vi.►1)LOLv 1 A ZIP /G� 3toS
PROPERTY OWNER PHONE
MAILING ADDRESS 14."' C/4 119 Pj ` /
�o n- r LA :72..-JL!✓ I W A' ZIP c 3 j
CONTRACTOR (1?
PHONE � � j p
MAILING ADDRESS Po �� --)--)OK 24 a
O' ,i mj ci,v�� uo ct ZIP `I/(��
8;2--6
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 a plicant's property or structure shall be requested and shall occur during regular business hours.
V �
APPLICANT SIGNATURE 6/ DATE / / 2,
/✓
FOR OFFICE USE ONLY
BASE FEE RECEIPT#
CASH/CK#
TOTAL DATE / /
H:tl-IOM E\PLNC NTR\I NFOB LDG\FORMS\I NSTALL.DOC 11/05/01