HomeMy WebLinkAboutBLD2002-00321 UILDING PERMIT APPLICASOI BLD02-00321N Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00321 Received Date: 6/5/2002
SITE ADDRESS: 135 OUTLOOK LN
PORT LUDLOW, 98365
OWNER: RICHARD J BORSINI PHONE:
601 UNION ST STE 5300
SEATTLE WA 98101-1356
SUBDIVISION: TEAL LAKE VILLAGE Block: Lot: 99
PARCEL NUMBER: 998700099 Section: 21 Township: 28 N Range: 01 E
CONTRACTOR: PETTIT OIL CO PHONE: (360)385-1420
PO BOX 1031
PORT TOWNSEND WA 98368
Contractor's License PETTIOCO88CC Expires 5/1/2004
REPRESENTATIVE(S):
PROJECT DESCRIPTION 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: 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 06/05/02 47777
Total: $47.00
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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 #: BLD02-00321 Received Date 6/5/2002
SITE ADDRESS: 135 OUTLOOK LN Issue Date 6/6/2002
PORT LUDLOW, 98365
APPLICANT: RICHARD J BORSINI PHONE:
601 UNION ST STE 5300
SEATTLE WA 98101-1356
99
SUBDIVISION: TEAL LAKE VILLAGE Block: Lot:
PARCEL NUMBER: 998700099 Section: 21 Township: 28N Range: 01 E
CONTRACTOR: PETTIT OIL CO PHONE: (360)385-1420
PO BOX 1031
PORT TOWNSEND WA 98368
Contractor's License PETTIOCO88CC Expires 5/1/2004
OWNER, RICHARD J BORSINI PHONE:
if different: 601 UNION ST STE 5300
SEATTLE WA 98101-1356
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 6/6/2003.
REQUIRED INSPECTIONS:
[LI T /Appliance ,1 4 :-4-
G]-._c_Firrdl ppA rovaT �c 5 ( Z
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
JEFFERSON COUNTY COMMUN•DEVELOPMENT,621 SHERIDAN ST,PORT TOWARD WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE PROPANE TANK PELLET STOVE X OTHER Pr-Of(rvt,e
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):
/ < :Sr Ca w / 2 >d(f' 0 t '
i i 1,..0466.4/ ZIP
9 DIGIT PARCEL ID NUMBER 9.9'0 7 e9U C' q
Legal Description:
Subdivision Name reet.L a-d e Block Lot(s) 9
Section l Township North, Range WM
APPLICANT PC #j~ 7 2 / PHONE 3 (P's-C - /Ya a
MAILING ADDRESS .3 Sc)1 o rt,
P.7-r LA)ut ZIP q/ d—��v�
PROPERTY OWNER 0/EC X /3 o r S''h l PHONE
MAILING ADDRESS 1 O/ /2 kt 63 b O
/'7`/e Al u-- ZIP n-/0/
CONTRACTOR Pe /7 � ®o( PHONE '5-5- ../6/1
MAILING ADDRESS c2 3 SG �`//fr
P17 . !/��`t` ZIP C. 3("(F
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
DATE � S/ / D
FOR OFFICE USE ONLY
BASE FEE _47.00 RECEIPT# /
CASH/CK#// s
I� V
TOTAL 'T DATE (o/ / 0Z
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