HomeMy WebLinkAboutBLD2002-00642 -410 •
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 #: BLD02-00642 Received Date 11/1/2002
SITE ADDRESS: 551 S BAY WAY Issue Date 11/1/2002
PORT LUDLOW, 98365
APPLICANT: GEORGE W LESLIE PHONE: (253)582-9408
GOLDIE L LESLIE
7705 ONYX DR SW
LAKEWOOD WA 98498-4847 74
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 921294002 Section: 29 Township: 29N 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, GEORGE W LESLIE PHONE: (253)582-9408
if different: GOLDIE L LESLIE
7705 ONYX DR SW
LAKEWOOD WA 98498-4847
PROJECT DESCRIPTION: PROPANE TANK&STOVE 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 11/1/2003.
REQUIRED INSPECTIONS:
[ I ; ank/Ain Appliance' i L-7Z.6 --'e-
[ -] FinalApproval ( 2 6 -�2
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
i:T_BLD_Permit_Propane.rpt 10/29/19
�UILDING PERMIT APPLICION BL 642
Revv iew iew T Tyype:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00642 Received Date: 11/1/2002
SITE ADDRESS: 551 S BAY WAY
PORT LUDLOW, 98365
OWNER: GEORGE W LESLIE PHONE: (253)582-9408
GOLDIE L LESLIE
7705 ONYX DR SW
LAKEWOOD WA 98498-4847
SUBDIVISION: Block: Lot: 74
PARCEL NUMBER: 921294002 Section: 29 Township: 29 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 DESCRIPTION PROPANE TANK & STOVE INSTALLATION
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 1997 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: 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 11/01/02 51285
Total: $47.00
JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWN ND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE X Above 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#/Road Name):
55/ South 13ay 6Y
Poe-7L Ludlow ZIP
9 DIGIT PARCEL ID NUMBER I Z.I ZQ 4 00-2-
Legal Description:
Subdivision Name Block Lot(s)
Section f,�/ Township North, Range WM
APPLICANT lJeor YYge. . Leslie— PHONE 253 —582—9408
MAILING ADDRESS 7 7o S Onyx 0ri ye, 6 W
Le ke wood, WA ZIP 18498 - *84 7
PROPERTY OWNER Georve, m7 Le site: PHONE
MAILING ADDRESS
ZIP
CONTRACTOR Mo urlfac hro�7
� ►'te PHONE 360 385- 6g g 3
MAILING ADDRESS 265 Cht N'I 2Cuvrh go zci
Pori Ndlock( WA ZIP 98339
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 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.
CjIlAPPLICANT SIGNATURE DATE /1 / / / 02--•
FOR OFFICE USE ONLY
/
BASE FEE I 4 - LTD RECEIPT# 5I,2$5
K#
TOTAL 4 - - DATE i I / l / d Zi
H:W OM E\P LN CNTR\I NFOBLDG\FORMS\I NSTALL.DOC 11/05/01