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HomeMy WebLinkAboutBLD2002-00404 • . 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 #: BLD02-00404 Received Date 7/16/2002 SITE ADDRESS: 685 LUDLOW BAY RD Issue Date 7/17/2002 PORT LUDLOW, 98365 APPLICANT: DWIGHT F HAUPTMAN TRSTEE PHONE: (360)437-8097 MARIANNE D P HAUPTMAN TRS PO BOX 65427 PORT LUDLOW WA 98365 6 SUBDIVISION: LUDLOW BEACH TRS 2 Block: Lot: PARCEL NUMBER: 969000006 Section: 16 Township: 28N Range: 01E CONTRACTOR: MOUNTAIN PROPANE LLC PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTPL994BH Expires 12/14/2002 OWNER, DWIGHT F HAUPTMAN TRSTEE PHONE: (360)437-8097 if different: MARIANNE D P HAUPTMAN TRS PO BOX 65427 PORT LUDLOW WA 98365 PROJECT DESCRIPTION: PROPANE TANK, STOVE & GAS LINE TO DRYER 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 7/17/2003. REQUIRED INSPECTIONS: [ I Tank/Line/Appliance © 9-0 2 [ I FinalApproval: t:)K 7;,I.1—v --L_— 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 0 BLD02-00404 UILDING PERMIT APPLICAILN Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD02-00404 Received Date: 7/16/2002 SITE ADDRESS: 685 LUDLOW BAY RD PORT LUDLOW, 98365 OWNER: DWIGHT F HAUPTMAN TRSTEE PHONE: (360)437-8097 MARIANNE D P HAUPTMAN TRS PO BOX 65427 PORT LUDLOW WA 98365 SUBDIVISION: LUDLOW BEACH TRS 2 Block: Lot: 6 PARCEL NUMBER: 969000006 Section: 16 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 DESCRIPTIOP PROPANE TANK, STOVE & GAS LINE TO DRYER 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: CONST TYPE: OTHER: 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 Bv: Date: Receipt: Approved/Date Propane Tanks/Stoves $47.00 MAM 07/16/02 49229 Total: $47.00 • JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWN ND WA 98368 PH: (360)379-4450 INSTALLATION PERMIT APPLICATION WOODSTOVE PROPANE TANK PELLET STOVE OTHER k, �"" -- C 2��-e, Is this appliance(htg stove, hot water tank,furnace, etc.)to be installed in a Manufactured/Mobile Home? YES y NO SITE ADDRESS(911#/Road Name): G' .s CLcd(UW g eok Lac +�lo z-J tatti ZIP (553 S 9 DIGIT PARCEL ID NUMBER !61 D 00006 Legal Description: `, Subdivision Name Block Lot(s) Section Township North, Range VVM APPLICANT (,ut iA R ��l � wtl�+V PHONE ?�4,U- 4,37- (�$69/� MAILING ADDRESS b S- CAA AL1 w 12?):31.-f 1•,V G ZIP (5A.C.S PROPERTY OWNER 9L)1 br\ F> l�fl1•0/cifvf PHONE AL) ^ 43/ - 8697 MAILING ADDRESS 1.,S 614 ZIP ` glcs ,( CONTRACTOR /14O(4,AJ nth;A) f/1-4 N PHONE MAILING ADDRESS V`S I l rµ q e 1n D g (Act.- 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 > Lz DATE � / � / 0 Z 6 FOR OFFICE USE ONLY rp Q BASE FEE y q--CT'd - CEIPT# 4 11 r D �..- E • SH/CK# -0/ TOTAL —f I TE �'7 I(p /C�Z .1(IL ) 6 2002 H:HOME\PLNC NTR\I NFOBLDG\FORMS\I NSTALL.DOC 11/05/01 Y DEPT. OF COMMUNITY DEVELOPMENT i