HomeMy WebLinkAboutBLD2002-00222 0 •
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 #: BLD02-00222 Received Date 4/17/2002
SITE ADDRESS: 50 GAMBLE LN Issue Date 4/17/2002
PORT LUDLOW, 98365
APPLICANT: ANNETTE E ISAKSEN-STONE PHONE: (360)437-0218
PO BOX 65084
PORT LUDLOW WA 98365-0084
8
SUBDIVISION: PORT LUDLOW NO. 1 AREA 1 Block: Lot:
PARCEL NUMBER: 990400108 Section: 9 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 9/6/2002
OWNER, ANNETTE E ISAKSEN-STONE PHONE: (360)437-0218
if different: PO BOX 65084
PORT LUDLOW WA 98365-0084
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 4/17/2003.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: /kris Love c:, e 5-1-0 z.
[if FinalApproval:k 1 ( - (H^u z-
v
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
1113UILDING PERMIT APPLICAI ON BLD02-00222
Review
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00222 Received Date: 4/17/2002
SITE ADDRESS: 50 GAMBLE LN
PORT LUDLOW, 98365
OWNER: ANNETTE E ISAKSEN-STONE PHONE: (360)437-0218
PO BOX 65084
PORT LUDLOW WA 98365-0084
SUBDIVISION: PORT LUDLOW NO. 1 AREA 1 Block: Lot: 8
PARCEL NUMBER: 990400108 Section: 9 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 9/6/2002
REPRESENTATIVE(S):
PROJECT DESCRIPTION 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: 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
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 MAM 04/17/02 46460
Total: $47.00
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JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNS ND WA 98368 PH: (360)379-4450
P A 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 �i� NO
SITE ADDRESS(911#/Road Name: L V
(rii - c
f y' / i"-- 10 a2A ZIP ? 5 7
9 DIGIT PARCEL ID NUMBER / 7-0 'Z' ,°^/e't
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT / >' 1 e--- ee_ - > eo'i PHONE 4/-.3 7-' a z ,
MAILING ADDRESS 5 ) J 7/3L L__./V
/ /77-" / .127/_04d / -62),4 ZIP 2 Ps 4
PROPERTY OWNER 1'1Yi e -4 ,k,;0/V PHONE /A 3 7 6 2-� `CT
MAILING ADDRESS �C, Kir9-/-9-2 z..-A/ -ry
/ 2 b1 ) 1&/, ZIP (572?, .�
CONTRACTOR (74e-----11 - �' ¢��
`�-f'� PHONE ���" ✓` .�U
MAILING ADDRESS / �i3' E'�v
K e c1- /72 ,i'toA ZIP W!30-___S-
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.
. '2
APPLICANT SIGNATURE (96t'1%Z `sy 71 17-C. , DATE I / �-.
FOR OFFICE USE ONLY / I_
BASE FEE in 0 �. �CEIPT# "'� lU L/ N Q
D _�.. C'AIS' H/CK# C 4S T/
TOTAL 1 I , °° APR 1 71001 E 'T l 17 , O
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DEPT. OF COMMUNITY DEVELOPMENT