HomeMy WebLinkAboutBLD2002-00501 • 41
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 #: BLD02-00501 Received Date 8/28/2002
SITE ADDRESS: 1662 IRONDALE RD Issue Date 8/29/2002
PORT HADLOCK, 98339
APPLICANT: RAYMOND A LAMBE PHONE: (206)779-3223
JUDITH A LAMBE
PO BOX 7363
SEATTLE WA 98107 4
SUBDIVISION: SHOLD'S ADDITION Block: B Lot:
PARCEL NUMBER: 994800504 Section: 2 Township: 29N Range: 01W
CONTRACTOR: MOUNTAIN PROPANE LLC PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPL994BH Expires 12/14/2002
OWNER, RAYMOND A LAMBE PHONE: (206)779-3223
if different: JUDITH A LAMBE
PO BOX 7363
SEATTLE WA 98107
PROJECT DESCRIPTION: U G PROPANE TANK 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 8/29/2003.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance �Q, J ?g/*M14,,Alif " '9,17412.-
[ ] FinalApproval: /3G<_-_k . / —i y--
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
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BUILDING PERMIT APPLIC'�'I"ION RBLD02-00501
eview Type:
Jefferson County Department of Community Development
62f1 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00501 Received Date: 8/28/2002
SITE ADDRESS: 1662 IRONDALE RD
PORT HADLOCK, 98339
OWNER: RAYMOND A LAMBE PHONE: (206)779-3223
JUDITH A LAMBE
PO BOX 7363
SEATTLE WA 98107
SUBDIVISION: SHOLD'S ADDITION Block: B Lot: 4
PARCEL NUMBER: 994800504 Section: 2 Township: 29 N Range: 01 W
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 DESCRIPTION U G PROPANE TANK 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 08/28/02 49537
Total: $47.00
...,
,,, ,,,,4 _.......
JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621HRIDAN ST,PORT TO END WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATIO
WOODSTOVE Above Ground PROPANE TANK PELLET STOVE OTHER IA ' G'1 ?roe9)/e )4n)
Is this appliance (htg stove, hot water tank,furnace,etc.)to be installed i a Manufactured/Mobile Home?
YES )‹ NO
SITE ADDRESS(911#/Road Name):
)66 a. rn ?cdq Ito JZo/
W
?Of/. tHgd4GY w,4 ZIP 9 533 9
9 DIGIT PARCEL ID NUMBER 5i.5 T - 150. `S0 T
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range M
APPLICANT ,4/O LAX i ✓I7 ?io�JI a PHONE 3 5S /- 4 S
�. L
MAILING ADDRESS ZbS C)7)179t �7QG1i6'' /Ld.
Pori VlQditacJ, vti fr ZIP 48 339
PROPERTY OWNER )ZC3 f 1-Qm b e PHONE Z016 - 779 -3.3-.2 3
MAILING ADDRESS p,o. go x )7363
Sec Oir , wel • 7 p 1 1D7 ZIP
CONTRACTOR /YMOIAN QJ/2 l't�,�f9L� PHONE ,$�/� C7 T.+
g 3
MAILING ADDRESS Z56 thin in go i, Q
Port 1,d , w't ZIP 9%33
STATE LICENSE# 47 p
otin) !1. 99,9 A EXP.DATE I Z /y 0.2.-
FEDERAL I.D.# 9 - 9 2.55
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 -//% DATE D /P` O / C)-Z.
FOR OFFICE USE ONLY BASE FEE 4( / QO RECEIPT# SI 9 J_3
/ } � i1'� `�,CQ,4 1 '' ) CASH/CK# i3�
TOTAL `-/ �( " DATE S.
/Q+O/ ci/
H:\HOME\PLNCNTR\INFOBLDG\FORMS\INSTALL.DOC11/05/01 AUG 2 8 2002
JEFFERSON COUNTY DCD
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