HomeMy WebLinkAboutBLD2002-00623 kUILDING PERMIT APPLICON B Review 3
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00623 Received Date: 10/18/2002
SITE ADDRESS: 3801 HASTINGS AVE W
PORT TOWNSEND, 98368
OWNER: PHILLIP L HARVEY PHONE: (360)385-1320
KAREN M HARVEY
3801 HASTINGS AVE W
PORT TOWNSEND WA 98368-9642
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 001072011 Section: 7 Township: 30 N Range: 01 W
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 DESCRIPTIOr PROPANE TANK, HEAT STOVE & GAS PIPE 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 10/18/02 51192
Total: $47.00
• •
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 #: BLD02-00623 Received Date 10/18/2002
SITE ADDRESS: 3801 HASTINGS AVE W Issue Date 10/21/2002
PORT TOWNSEND, 98368
APPLICANT: PHILLIP L HARVEY PHONE: (360)385-1320
KAREN M HARVEY
3801 HASTINGS AVE W
PORT TOWNSEND WA 98368-9642
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 001072011 Section: 7 Township: 30N Range: 01W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2002
OWNER, PHILLIP L HARVEY PHONE: (360)385-1320
if different: KAREN M HARVEY
3801 HASTINGS AVE W
PORT TOWNSEND WA 98368-9642
PROJECT DESCRIPTION: PROPANE TANK, HEAT STOVE & GAS PIPE 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 10/21/2003.
REQUIRED INSPECTIONS:
[ ] Tank/Line/AppliancefO�
[ ] FinalApproval: , -- , 1 (` ( Th— 02__
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_B LD_Permit_Propa ne.rpt 10/29/19
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JEFFERSON COUNTY COMMUN•EVELOPMENT,621 SHERIDAN ST,PORT TOW WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* ✓Above Ground PROPANE TANK L' HEAT STOVE HOT WATER TANK
WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE
OTHER(Please Specify)
Is this appliance(htg stove, hot water tank,furnace,etc.)to be installed in a Manufactured/Mobile Home?
YES X NO
SITE ADDRESS(911#/Road Name):
ago/ \/
ZIP
9 DIGIT PARCEL ID NUMBER 0 - (
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT :;)11`'- ‘--,r-- PHONE 3 �- /3 L D
MAILING ADDRESS
ZIP
PROPERTY OWNER ardiak PHONE �r
MAILING ADDRESS
ZIP
SUNSHINE PROPANE
CONTRACTOR _'"Quality Energy Services Since 1980 it PHONE
10853 Rhody Dr.Hadlock,WA 98339"=E
MAILING ADDRESS (360)385-5797 or 683-4010
ZIP
STATE LICENSE# � L"'S 171-P 0 77 c EXP. DATE /// b
FEDERAL I.D.# � — /D 7 2 8'f—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'S SIGNATURE DATE / v / /7 / 0 L
,O FICUgIALYV E
•
BASE FEE EIPT#
CONSISTENCY REVIEW OCT 1 8 2002 SH/CK#
TOTAL • DATE / /
*Underground Propane Tank applications require additional information to be submitted.r Please contact our office at 360-379-4450 if the back of
this application is blank.
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