HomeMy WebLinkAboutBLD2002-00478 + • 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#: BLD02-00478 Received Date 8/21/2002
SITE ADDRESS: 6674 OAK BAY RD Issue Date 8/22/2002
PORT LUDLOW, 98365
APPLICANT: JASON J WOODS PHONE: 360-437-9857
ROBIN HANSEN
51 FERNRIDGE LN
PORT LUDLOW WA 983659546 T 16
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 821051011 Section: 5 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, JASON J WOODS PHONE: 360-437-9857
if different: ROBIN HANSEN
51 FERNRIDGE LN
PORT LUDLOW WA 983659546
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 08/22/2003.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[ ] FinalApproval: O< 8/Z7/OZ,,i 1/
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
BLD02-00478
QUILDING PERMIT APPLICA A N Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD02-00478 Received Date: 8/21/2002
SITE ADDRESS: 6674 OAK BAY RD
PORT LUDLOW, 98365
OWNER: JASON J WOODS PHONE: 360-437-9857
ROBIN HANSEN
51 FERNRIDGE LN
PORT LUDLOW WA 983659546
SUBDIVISION: Block: Lot: T 16
PARCEL NUMBER: 821051011 Section: 5 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 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: 6?-/z i / )7 Shoreline Aquifer
Forest: Commercial Rural
Proximity _ Plat Conditions
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 ZAN 08/21/02 49516
Total: $47.00
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JEFFERSOfN COUNTY COMMMTY DEVELOPMENT.e2j SHERIDAN ST,PO9LTOWNSEMP t1Ug 083i98.PH; (3eM STh-4450 _
DEPT. OF VEi_tJPr,9ENT
INSTALLATION PERMIT APPLICATION ,.
�,.WOODSTOVE Bove 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#t Road Name):
C\ \C ZIP Ct
9 DIGIT PARCEL ID NUMBER D,2 1 o5 )D
Legal Description;
Subdivision Name „_, Block Lots}
Section S Township a!? North, Range 1 F _ wi i
APPLICANT c ' Af-Jt i "`-()C cLTh PHONE ,.? 7(j L7'3r)—(' i)-le)
MAILING ADDRESS a ic"1 P:0 r
,„;
.-% Ia bit r t�i � E x;. , SIP ...
PROPERTY OWNER IC;f: 6".\ k t PHONE, Car.„) 437-C SS 7
MAILING ADDRESS 51 PPf�1 2 .A, (- -
FT , ( C(.1 c,)( , 0 ZIP q,s (0 5
CONTRACTOR _56 PHONE
MAILING ADDRESS InP.
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 voii,
I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court coats,reasonable ettomCv`s fees and expenses which
may In any way accrue against Jefferson County as a result of of in consequence of the granting of this permit.
1 fUfther 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 left Inspections, Access and right of entry to the applicant's property or structure shall be requested end shall occur during regular business hours.
-2 APPLICANT SIONATURE (�J+-] C-'i i DATE Sr / III 1 L�_ .-
FOR OFFICE USE ONLY.
BASE I"EE RECEIPTS • r a ;r`; ; r
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