HomeMy WebLinkAboutBLD2002-00470 • 0
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 #: BLD02-00470 Received Date 8/19/2002
SITE ADDRESS: 281 SHORE DR Issue Date 8/20/2002
PORT LUDLOW, 98365
APPLICANT: BLUE MOUNTAIN REAL PROPERTIES PHONE: (888)425-0999
1501 ABERDEEN AVE NE
RENTON WA 98056-2820
16
SUBDIVISION: PARADISE BAY ESTATES Block: 14 Lot:
PARCEL NUMBER: 983401413 Section: 23 Township: 28N Range: 01 E
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2002
OWNER, BLUE MOUNTAIN REAL PROPERTIES PHONE: (888)425-0999
if different: 1501 ABERDEEN AVE NE
RENTON WA 98056-2820
PROJECT DESCRIPTION: PROPANE TANK& 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 8/20/2003.
REQUIRED INSPECTIONS:
[7 Tank/Line/Appliance:- -fiath& A.,/ An_ o 8//0 l
l
[/ inaIAppr�oval QK -QOr / / 03• a
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
UILDING PERMIT APPLICATION B RDO�004pe70
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00470 Received Date: 8/19/2002
SITE ADDRESS: 281 SHORE DR
PORT LUDLOW, 98365
OWNER: BLUE MOUNTAIN REAL PROPERTIES PHONE: (888)425-0999
1501 ABERDEEN AVE NE
RENTON WA 98056-2820
SUBDIVISION: PARADISE BAY ESTATES Block: 14 Lot: 16
PARCEL NUMBER: 983401413 Section: 23 Township: 28 N Range: 01 E
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2002
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION PROPANE TANK & INSERT 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:
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 By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 MAM 08/19/02 49449
Total: $47.00
JEFFERSON COUNTY COMMUNDEVELOPMENT,621 SHERIDAN ST,PORT TOWNSEND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION WOODSTOVE Above Ground PROPANE TANK PELLET STOVE ��OTHER .O"/�
-e--77/714PP
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):
y( J// g-6 �c.
G-. Gt-J'1.,D c,J 64) ZIP / a C 1--
9 DIGIT PARCEL ID NUMBER / Q 3 / O / 7/ 3
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
�C., p b
APPLICANT g ,i, ' " `/?L_ a'`-r w PHONE 8'O a - 4Zi--- 0 Q
MAILING ADDRESS //`� C) ifDyC 3/ b
/Y
Otg9-g-/ f CJ(- ZIP TU 4D2-
PROPERTY OWNER C73/ c.4 PHONE S
MAILING ADDRESS s
ZIP
CONTRACTOR 41,0 pC PHONE 6 Oi T 6/d
MAILING ADDRESS /0 67,r3 gLe D r ,1 fell,sr- tic. , Zj cell e__ ZIP f f
STATE LICENSE# ,5-444,5-/7'1/-,k Q 77 Q i' EXP.DATE //l/OL-
FEDERAL I.D.# 7/ -/ 7 T c'3 7
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 a"---- - ('(2FY-,44PP//e4f7'-7-
I DATE / /L / v Z"--
(11:94-
FOR OFFICE USE ONLY �Q
BASE FEE RECEIPT# '/"T ! 9
CASH/CK# 9014
I
TOTAL 14 'OD DATE p / L (/0.0)--
H:\HOME\PLNCNTR\INFOBLDG\FORMS\INSTALL.DOC 11/05/01