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HomeMy WebLinkAboutBLD2002-00421 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 #: BLD02-00421 Received Date 7/24/2002 SITE ADDRESS: 274 PORT HADLOCK HEIGHTS RD Issue Date 7/24/2002 PORT HADLOCK, 98339 APPLICANT: ANTONIO LOPEZ PHONE: 360-385-6057 C/O BRODERS INC 4503 OLD GARDINER RD PORT TOWNSEND WA 98368-9778 1-45 SUBDIVISION: PORT HADLOCK HEIGHTS MH PARK Block: Lot: PARCEL NUMBER: 989500001 Section: 11 Township: 29N Range: 01W CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTPL994BH Expires 12/14/2002 OWNER, ANTONIO LOPEZ PHONE: 360-385-6057 if different: C/O BRODERS INC 4503 OLD GARDINER RD PORT TOWNSEND WA 98368-9778 PROJECT DESCRIPTION ABOVE GROUND PROPANE TANK 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 07/24/2003. REQUIRED INSPECTIONS: [ ] Tank/Line/Appliance: [ ] FinalApproval: i�j< 1 t —22-0 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 lik UILDING PERMIT APPLICA c)N BR DO-00 90 eview Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BBLD02-00421 Received Date: 7/24/2002 SITE ADDRESS: 274 PORT HADLOCK HEIGHTS RD PORT HADLOCK, 98339 OWNER: ANTONIO LOPEZ PHONE: 360-385-6057 C/O BRODERS INC 4503 OLD GARDINER RD PORT TOWNSEND WA 98368-9778 SUBDIVISION: PORT HADLOCK HEIGHTS MH PARK Block: Lot: 1-45 PARCEL NUMBER: 989500001 Section: 11 Township: 29 N Range: 01 W CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTPL994BH Expires 12/14/2002 REPRESENTATIVE: PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIO ABOVE GROUND PROPANE TANK 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 F&W Landslide Routing Date: -7/ / Shoreline Aquifer �'9 G b 2- Forest: Commercial Rural Proximity_ Plat Conditions Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $47.00 ZAN 07/24/02 49328 Total: $47.00 JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNS D WA 98368 PH: (360)379-4450 INSTALLATION PERMIT APPLICATION WOODSTOVE Above Ground PROPANE TANK PELLET STOVE OTHER Is this appliance(htg stove, hot water tank,furnace, etc.)to be installed in a Manufactured/M bile Home? 4 YES NO SITE ADDRESS(911#/Road Name:Pc p / re f l r cic K izs re)NIBE(ZR / 71i1)1oc k � ZIP 33 / 9 DIGIT PARCEL I �� j 5 �Q©© ! Legal Description: Gt 4 _ L e'c 6 4,l' � Subdivision Name I `7 ��/T 5 Block Lot(s) �/// Section /� Township North, Range WM APPLICANT �/V /G N''d to , i4 G14E�Z PHONE ! "MAILING ADDRESS °' 8 A l o 9O / )�/e T //nt pi 0 e l4..,j �£4j ZIP 7U 33 � PROPERTY OWNER XZ6eie tZ XA)C— PHONE - 777 7 VO? MAILING ADDRESS ZIP CONTRACTOR f l d v/✓ l if/do l t?G Pe A/e_ PHONE 5 e - 6 e3 -`e8/ MAILING ADDRESS 7- CeT 1 ii /J C-(.1 e'J I Z_ 1-r I f ca ec k / w 0' l f3$y 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 49- " "` -...... -_..._._ DATE V /2Y / Z '') FOR OFFICE USE ONLY BASE FEE l ' RECEIPT# CASH/CK# TOTAL DATE / / H:\HOME\PLNCNTR\INFOBLDG\FORMS\INSTALL.DOC 11/05/01