HomeMy WebLinkAboutBLD2002-00377 "MD 90
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 #: BLD02-00377 Received Date 7/1/2002
SITE ADDRESS: 200 SHINE RD Issue Date 7/2/2002
PORT LUDLOW, 98365
APPLICANT: THOMAS L CARPENTER TR PHONE: (360)437-8181
LINDA L CARPENTER TR
200 SHINE RD
PORT LUDLOW WA 98365 2
SUBDIVISION: R SHAW SHORT PLAT Block: Lot:
PARCEL NUMBER: 821333021 Section: 33 Township: 28N Range: 01 E
CONTRACTOR: FERRELLGAS PHONE: (360)582-0231
646 SO 3RD AVE
SEQUIM WA 98382
Contractor's License FERRELP055LH Expires 8/1/2002
OWNER, THOMAS L CARPENTER TR PHONE: (360)437-8181
if different: LINDA L CARPENTER TR
200 SHINE RD
PORT LUDLOW WA 98365
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 7/2/2003.
REQUIRED INSPECTIONS:
[ ] Tank/Li /Appliance:itf2/< 2-7-Q e
[ �] FinalApproval: r,, l: 12Q -U 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
LDING PERMIT APPLICATIS B RDOe 00w pe 7
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00377 Received Date: 7/1/2002
SITE ADDRESS: 200 SHINE RD
PORT LUDLOW, 98365
OWNER: THOMAS L CARPENTER TR PHONE: (360)437-8181
LINDA L CARPENTER TR
200 SHINE RD
PORT LUDLOW WA 98365
SUBDIVISION: R SHAW SHORT PLAT Block: Lot: 2
PARCEL NUMBER: 821333021 Section: 33 Township: 28 N Range: 01 E
CONTRACTOR: FERRELLGAS PHONE: (360)582-0231
646 SO 3RD AVE
SEQUIM WA 98382
Contractor's License FERRELP055LH Expires 8/1/2002
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: 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 07/01/02 49122
Total: $47.00
•
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 X NO
SITE ADDRESS(911#/Road Name):
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i 1 1 A \ eJ `e'S ZIP 9 3 Lo
9 DIGIT PARCEL ID NUMBER ?t)- \ 3 3 (/c)
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range W
M
APPLICANT \-�. -��,`34Ji,St PHONE 3�' L9 E3--- J O� 7
MAILING ADDRESS S)`" t...1) `�F`3 • ` 4",...C- \Y "<--
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PROPERTY OWNER t .-(\�-e (s...J_c\... PHONE 360'q 3 "1' V r &
MAILING ADDRESS (-3O0 vim' ‘4*' t ''-.0 ?.d
L.-.._)Ca tL-5L _1 .;u''-N ZIP ' . k 3CoS
CONTRACTOR \--•e• `e- U.5 PHONE 3OD_ Co3 .- °Del
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MAILING ADDRESS '- ...-e S . vtr L C\ e
5-v. D..�.‘,, J.JAPt' ZIP 3 O¢ d"
STATE LICENSE# ( (`) n..1 \ --e D 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 SIGNATUREr. DATE < / ( / et `
FOR OFFICE USE ONLY
BASE FEE RECEIPT# Ln 1 a.-
CASH/CK# Cam}-{'
TOTAL DATE /-4—Cp
H:\HOME\PLNCNTR\I NFOBLDG\FORMS\I NSTALL.DOC 11/05/01