HomeMy WebLinkAboutBLD2002-00441 • •
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
PERMIT #: BLD02-00441 Received Date 8/7/2002
SITE ADDRESS: 784 OLYMPUS BLVD Issue Date 8/7/2002
PORT LUDLOW, 98365
APPLICANT: GWINN L DUNHAM JR PHONE: (360)437-2975
JOYCE A DUNHAM
784 OLYMPUS BLVD
PORT LUDLOW WA 983659416 3
SUBDIVISION: BASALT BEACH Block: 1 Lot:
PARCEL NUMBER: 931500102 Section: 4 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, GWINN L DUNHAM JR PHONE: (360)437-2975
if different: JOYCE A DUNHAM
784 OLYMPUS BLVD
PORT LUDLOW WA 983659416
PROJECT DESCRIPTION PROPANE TANK AND FIREPLACE INSERT 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 08/07/2003.
REQUIRED INSPECTIONS:
/[ ] Tank/Line/Appliance: .es, �/3AOZ cfr7
00
[ ] FinalApproval: 49X/ 0ZZ /y
7/
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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
• BUILDING PERMIT APPLIPTION BRDOWOOpe 1
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD02-00441 Received Date: 8/7/2002
SITE ADDRESS: 784 OLYMPUS BLVD
PORT LUDLOW, 98365
OWNER: GWINN L DUNHAM JR PHONE: (360)437-2975
JOYCE A DUNHAM
784 OLYMPUS BLVD
PORT LUDLOW WA 983659416
SUBDIVISION: BASALT BEACH Block: 1 Lot: 3
PARCEL NUMBER: 931500102 Section: 4 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: PHONE:
PROJECT DESCRIPTIO PROPANE TANK AND FIREPLACE INSERT INSTALLATION
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 1997 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: 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
F&W Landslide
Routing Date: Shoreline�1� !7' � Aquifer
(J CJ r Forest: Commercial Rural
Proximity Plat Conditions
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 PRB 08/07/02 49463
Total: $47.00
• •
JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNSEND WA 98368 PH: (360)379-4450
y
INSTALLATION PERMIT APPLICATION
WOODSTOVE Above Ground PROPANE TANK PELLET STOVE OTHER
Is this appliance (htg stove, hot water tank,furnace, etc.)to be installed in a Manufactured/Mobile Home?
YES NO
SITE ADDRESS(911#/Road Name): Lt D ,^A S / Li ) ,
ect
6
1 0 t L t& Cl 10 to ZIP 4? v 3 4 5
9 DIGIT PARCEL ID NUMBER `5 1 irsp('' tn.—
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT G to i YI k L. - 17L.U'tI4$f v r PHONE ` 3 7 -02 ` 75--
MAILING ADDRESS 7 D ‘74 0 ! v illy �s 6 G V 4+ '
re e 1- 2�.d 0e cot L.)a.5%- ZIP 83 6
PROPERTY OWNER 5 G_hi, e. Ct.S 6O u e- PHONE
MAILING ADDRESS
ZIP
CONTRACTOR M d I t Pt_+Gt. 1 n Prof&yL e PHONE
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 L#t 4. DATE / (J 02"'.---_
FOR OFFICE USE ONLY
47 1
BASE FEE 2..: / RECEIPT# 4943
CASH/CK# Qsz6
TOTAL 47"I— DATE V'/7 /D —
H:\HOME\PLNCNTR\IN FOBLDG\FORMS\I NSTALL.DOC 11/05/01