HomeMy WebLinkAboutBLD2002-00632 • •
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 #: BLD02-00632 Received Date 10/24/2002
SITE ADDRESS: 851 WALKER WAY Issue Date 10/25/2002
PORT LUDLOW, 98365
APPLICANT: PEGGY L SCHAFRAN PHONE: (360)437-9935
12 PAR 4 CT
PORT LUDLOW WA 98365-9582
77
SUBDIVISION: PORT LUDLOW NO. 4 Block: Lot:
PARCEL NUMBER: 990500077 Section: 8 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, PEGGY L SCHAFRAN PHONE: (360)437-9935
if different: 12 PAR 4 CT
PORT LUDLOW WA 98365-9582
PROJECT DESCRIPTION: PROPANE TANK, STOVE & 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 10/25/2003.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance 6 )CY. -
r
[ ] FinalApproval: (A.1 Gvive/< ) /- IZ -6--•,_
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
tUILDING PERMIT APPLICAONBLD02-00632 Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00632 Received Date: 10/24/2002
SITE ADDRESS: 851 WALKER WAY
PORT LUDLOW, 98365
OWNER: PEGGY L SCHAFRAN PHONE: (360)437-9935
12 PAR 4 CT
PORT LUDLOW WA 98365-9582
SUBDIVISION: PORT LUDLOW NO. 4 Block: Lot: 77
PARCEL NUMBER: 990500077 Section: 8 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 DESCRIPTIOP PROPANE TANK, STOVE & 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
Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 MAM 10/24/02 51257
Total: $47.00
JEFFERSON COUNTY COMMU.EVELOPMENT,621 SHERIDAN ST,PORT TOWN,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 x HEAT STOVE HOT WATER TANK
WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE
1 t
OTHER(Please Specify) —I�101' L
Is this appliance(htgstove, hot water tank,furnace,etc.)to be installed in a l�ganufa r /pp ctu ed Moblle Home?
YES NO
SITE ADDRESS(911#/Road Name): p /.
4-1-0 Lcrzf / (� ZIP • (f.1
9 DIGIT PARCEL ID NUMBER 490 Soo 077
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range VVM
APPLICANT e. C 11/1 k WY`0,/'IL._ PHONE J]-
MAILING ADDRESS 0411 ` � C✓a" Pi G 4
G lv✓I(-0� ZIP
PROPERTY OWNER y—► c a-,1 PHONE
MAILING ADDRESS JZ�
ZIP
CONTRACTOR dam'" l a'i0°" PHONE
MAILING ADDRESS /o d-S 3
P( )/4 Ci I tJ ZIP 339
STATE LICENSE# =C��� 7. rn24 C 7 7 Y ° EXP.DATE
FEDERAL I.D.# I - J O 7 91 ,y
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.
APPLICANTS SIGNATURE DATE
FOR OFFICE USE ONLY —7
BASE FEE _ ( RECEIPT# 5i
E 04 CONSISTENCY REVIEW .-_� a CASH/CK# CI I 1 9
TOTAL I DATE l 0 /)-11 /na___
J 0CT2420W
*Underground Propane Tank applications require additiona information to be submitte Please contact our office at 360-379-4450 if the back of
this application is blank.
DEPT. OF COMMUNITY DEVELOPMENT
H:HOME\PLNCNTR\INFOBLDG\FORMS\INSTALL.DOC