HomeMy WebLinkAboutBLD2002-00250 • •
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 #: BLD02-00250 Received Date 5/1/2002
SITE ADDRESS: 930 OLELE POINT RD Issue Date 5/1/2002
PORT LUDLOW, 98365
APPLICANT: DAVID S GURNEE PHONE:
NANCY A GURNEE
930 OLELE POINT RD
PORT LUDLOW WA 98365-9413
SUBDIVISION: OLELE POINT Block: Lot:
PARCEL NUMBER: 977400032 Section: 33 Township: 29N Range: 01 E
CONTRACTOR: PORT ORCHARD HEATING PHONE: 437-8222
824 BYWATER WAY
PORT LUDLOW WA 98365
Contractor's License PORTOHA084OB Expires 9/1/2002
OWNER, DAVID S GURNEE PHONE:
if different: NANCY A GURNEE
930 OLELE POINT RD
PORT LUDLOW WA 98365-9413
PROJECT DESCRIPTION: PROPANE TANK, COOKSTOVE, FURNACE, GENERATOR, BBQ
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 5/1/2003.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: f F.'& ® A.j-c.. 5--6-o
[ ] CaIApproval: 4K -or 6/) S/3o/�3
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
BLD02-00250
litUILDING PERMIT APPLICAON Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00250 Received Date: 5/1/2002
SITE ADDRESS: 930 OLELE POINT RD
PORT LUDLOW, 98365
OWNER: DAVID S GURNEE PHONE:
NANCY A GURNEE
930 OLELE POINT RD
PORT LUDLOW WA 98365-9413
SUBDIVISION: OLELE POINT Block: Lot:
PARCEL NUMBER: 977400032 Section: 33 Township: 29 N Range: 01 E
CONTRACTOR: PORT ORCHARD HEATING PHONE: 437-8222
824 BYWATER WAY
PORT LUDLOW WA 98365
Contractor's License PORTOHA084OB Expires 9/1/1999
REPRESENTATIVE(S):
PROJECT DESCRIPTIOI PROPANE TANK, COOKSTOVE, FURNACE, GENERATOR, BBQ
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
Routing Date: F&W Landslide
Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid Bv: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 MAM 05/01/02 47568
Total: $47.00
410
JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNSEND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
D o i O of FL-An,r u,4 GG a U0a-Pc'c
WOODSTOVE zA <PROPANE TANK PELLET STOVE OTHER (v
Is this appliance(htg stove, hot water tank,furnace, etc.)to be installed in a Manufactured/Mobile Homey
YES .,, :i)k10
SITE ADDRESS(911#/Road Name):
0 OLC,( (PT. OR D.
Fb C‘ C U(LC. (t) //,�6UA , ZIP 6 c
GI 1 9 DIGIT PARCEL ID NUMBER T . 4W ' 0-32,
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT _k )1 ()/,e) 6---u,t Jsc PHONE [� q. ?v733
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MAILING ADDRESS
ZIP
PROPERTY OWNER A IAA,l'�, PHONE
MAILING ADDRESS
ZIP
CONTRACTOR 4vPCX -co LC- A ( M AT /Ji?r PHONE C- 3 7 g 2,�- "e_._
MAILING ADDRESS
ZIP
STATE LICENSE# 6. 6- pc(yc c'0(--/A` 5250-(-((,) 6 EXP.DATE ? -/- Q
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 a �,1 /� DATE `� / / /v 2
' 4 FOR OFFICE USE ONLY / 2 S�(!/�
BASE FEE `�1 RECEIPT# T pa
TOTAL Li 4 D 110.1 lC DYE /_i_i_02._
H:\HOME\PLNCNTR\INFOBLDG\FORMS\INSTALL.D0C11/05/01 MAY - 1 2002
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