HomeMy WebLinkAboutBLD2002-00531 • • . .
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#: BLD02-00531 Received Date 9/12/2002
SITE ADDRESS: 180 WERNER RD Issue Date 9/12/2002
PORT LUDLOW, 98365
APPLICANT: DANIEL A GALLAWAY PHONE:
BETTE J WALLACE
180 WERNER RD
PORT LUDLOW WA 983659751
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 821082004 Section: 8 Township: 28N Range: 01 E
CONTRACTOR: ADVANCED HEATING & COOLING PHONE: (360)415-9335
1211 IVY RD
BREMERTON WA 98310
Contractor's License ADVANHCO22NF Expires 08/21/2003
OWNER, DANIEL A GALLAWAY PHONE:
if different: BETTE J WALLACE
180 WERNER RD
PORT LUDLOW WA 983659751
PROJECT DESCRIPTION PROPANE FIREPLACE AND PIPING
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 09/12/2003.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliances 0 2 `-- ' a 17. '��
[ ] FinalApproval: Gc,.',O ,'A('c' L-
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
IRUILDING PERMIT'APPLICA N BRD02 00eviewp5e31
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00531 Received Date: 9/12/2002
SITE ADDRESS: 180 WERNER RD
PORT LUDLOW, 98365
OWNER: DANIEL A GALLAWAY PHONE:
BETTE J WALLACE
180 WERNER RD
PORT LUDLOW WA 983659751
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 821082004 Section: 8 Township: 28 N Range: 01 E
CONTRACTOR: ADVANCED HEATING & COOLING PHONE: (360)415-9335
1211 IVY RD
BREMERTON WA 98310
Contractor's License ADVANHCO22NF Expires 08/06/2000
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIO PROPANE FIREPLACE AND PIPING
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
Routing Date: F&W Landslide
�/��2 Shoreline Aquifer
111 Forest: Commercial Rural
Proximity Plat Conditions
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 ZAN 09/12/02 50957
Total: $47.00
JEFFERSON COUNTY COMMUNI•EVELOPMENT,621 SHERIDAN ST,PORT TOWNS D WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE Above Ground PROPANE TANK PELLET STOVE OTHER GP Z r2 0a ._
Is this appliance (htg stove, hot water tank, furnace, etc.)to be installed in a Manufactured/Mobile Home?
YES PC NO
SITE ADDRESS(911#/Road Name):
""
Poo. Lsci 10LJ ZIP q'18' 36 S
9 DIGIT PARCEL ID NUMBER -1 0K-06`1
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT Ativo.vtc,7s 2,„ r03 .. Loa „,L4;_ PHONE 3( tJ• Lll,S-93 3 S
MAILING ADDRESS l ZZ-/1 ILA./ U._
iSrtinn- r4ay. r..:A' ZIP 5'I'3/4
PROPERTY OWNER pain C6c/I o L.:1,_y PHONE 4/37- 76 Z Z_
MAILING ADDRESS /K. li.)c. ev (I,c
Psi- 1 f ' ZIP r7 '-'365
CONTRACTOR +te s )Necrl'tvr, •f- err./,„s ,Lr tL PHONE 366 L//$- qi,3 3 S
MAILING ADDRESS 1241 Xt.)-1 (LQ.
16,i,yvter-M'-' (-SA- ZIP `i '3/0
STATE LICENSE# 4D•J A' A)#-(C-O&Z-A r 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 DATE 7 1 it1 UL
FOR OFFICE USE ONLY Q
BASE FEE RECEIPT# SD / 7
CASH/CK# // eVer
TOTAL 9 .(J DATE ) / /Z/ D
H:\HOME\PLNCNTR\INFOBLDG\FORMS\I NSTALL.DOC 11/05/01