HomeMy WebLinkAboutBLD2002-00285 • •
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 #: BLD02-00285 Received Date 5/15/2002
SITE ADDRESS: 6992 OAK BAY RD Issue Date 5/15/2002
PORT LUDLOW, 98365
APPLICANT: GARY L CORMAN PHONE: (360)437-2612
PO BOX 71
PORT HADLOCK WA 98339-0071
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 821051004 Section: 5 Township: 28N Range: 01 E
CONTRACTOR: MOUNTAIN PROPANE LLC PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPL994BH Expires 12/14/2002
OWNER, GARY L CORMAN PHONE: (360)437-2612
if different: PO BOX 71
PORT HADLOCK WA 98339-0071
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 5/15/2003.
REQUIRED INSPECTIONS:
[ l Tank/Li /Appliance: te=:_r'-- s-- � t,Jif ( pokik 6 --(6-c `2..
/9[ FinalApproval: 7l< e --,9.5---c,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
4143UILDING PERMIT APPLICAION B RDOe 00285
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00285 Received Date: 5/15/2002
SITE ADDRESS: 6992 OAK BAY RD
PORT LUDLOW, 98365
OWNER: GARY L CORMAN PHONE: (360)437-2612
PO BOX 71
PORT HADLOCK WA 98339-0071
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 821051004 Section: 5 Township: 28 N Range: 01 E
CONTRACTOR: MOUNTAIN PROPANE LLC PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPL994BH Expires 12/14/2002
REPRESENTATIVE(S):
PROJECT DESCRIPTIOI PROPANE TANK INSTALLATION
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 By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 MAM 05/15/02 47667
Total: $47.00
41,JEFFERSON COUNTY COMMUNDEVELOPMENT,621 SHERIDAN ST,PORT TOWN ND WA 98368 PH: (360)379-4450
aayy 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 Z NO
SITE ADDRESS(911 #/Road Name):
G 99 2 o 3-t\` '
'Po t\- V C .3 `,..% ZIP
9 DIGIT PARCEL ID NUMBER r 0 S 1 0 0 y
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT Pc`�`'� `C `n'� �QV� PHONE Li Zr-is +a• \1--
MAILING ADDRESS T U Wk 71 1
�ot \A o,.\L ZIP � C62
PROPERTY OWNER �( �.r��� PHONE 11 3 4-1^ 26 1-4----
MAILING ADDRESS
ZIP
CONTRACTOR , '\0 v"n1*C`Q,' '0 6 Ar e._ PHONE % S. - T5 ES-3
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.
APPLICANT SIGNATURE ✓�, i xJ\ DATE / /-S / 0 2--
BASE FEE F D U,3FLY� n rt ' RE IPT# jc�
/ ' � y CA rCK# t 5 L
TOTAL '--, - (SU 1 1 5s/ 1 c/d 2
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