HomeMy WebLinkAboutBLD2002-00452 • •
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#: BLD02-00452 Received Date 8/12/2002
SITE ADDRESS: 81 S KEEL WAY Issue Date 8/12/2002
PORT LUDLOW, 98365
APPLICANT: BOBBI L CLARK PHONE:
81 S KEEL WAY
PORT LUDLOW WA 98365
13
SUBDIVISION: LUDLOW POINT VILLAGE DIV 2 Block: Lot:
PARCEL NUMBER: 969500013 Section: 17 Township: 28N Range: 01 E
CONTRACTOR: PETTIT OIL CO PHONE: (360)385-1420
PO BOX 1031
PORT TOWNSEND WA 98368
Contractor's License PETTI00088CC Expires 05/01/2004
OWNER, BOBBI L CLARK PHONE:
if different: 81 S KEEL WAY
PORT LUDLOW WA 98365
PROJECT DESCRIPTION
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 08/12/2003.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: /141,kC7'ED 414L rpFF- a Pices >c' l& Ta-R. V �..I,Je-c
B+4ZSF.Qua, Pit
tR 4TCKEIJ -1,4v‘
[ FinalApproval: D1< q(° 75/43
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
BLD02-00452
RILDING PERMIT APPLICATI N Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00452 Received Date: 8/12/2002
SITE ADDRESS: 81 S KEEL WAY
PORT LUDLOW, 98365
OWNER: BOBBI L CLARK PHONE:
81 S KEEL WAY
PORT LUDLOW WA 98365
SUBDIVISION: LUDLOW POINT VILLAGE DIV 2 Block: Lot: 13
PARCEL NUMBER: 969500013 Section: 17 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 05/01/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIO
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: Wri/70.2_— /, Shoreline Aquifer
('`" Forest: Commercial Rural
Proximity Plat Conditions
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 PRB 08/12/02 49474
Total: $47.00
• •
JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNSEND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION�/
WOODSTOVE Above Ground PROPANE TANK PELLET STOVE /� OTHER J '�/e//N'('�
Is this appliance (htg stove, hot water tank,furnace,etc.)to be installed in a Manufactured/Mobile Home?
%2 YES ( NO
SITE ADDRESS(911#/Road Name): IP
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..
pia z.e/itki
/ ZIP 7
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9 DIGIT PARCEL ID NUMBER 749 Cg a/$
Legal Description:
Subdivision Name Block Lot(s)
Section W
,1 Township North, Range // M
APPLICANT _X,�d /7). 7 / Z�� � (i . PHONE 5I -77�
MAILING ADDRESS .S..4/ idele• ,/'
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,Gfi' -- ZIP (atio f
PROPERTY OWNER J (_• PHONE
MAILING ADDRESS c ( `-4C/ / (mot/ c?
n- / /I ���� i ZIP O J(P
CONTRACTOR dc,jid �(X ao • PHONE gC2CC e00
MAILING ADDRESS ��y! £ ?C /� / 2i (,
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, bt/ ZIP ��J(�D
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/` 4/17/2/4--(e."------ DATE //9- ��
FOR OFFICE USE ONLY
BASE FEE 4740 RECEIPT# �4-7
CASH/CK# Cr 1 -'
TOTAL Al
'CO DATE /2/ 02-®--
H:\HOME\PLNCNTR\INFOBLDG\FORMS\I NSTALL.DOC 11/05/01