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Home My WebLink AboutBLD2002-00647 • • 1 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 #: BLD02-00647 Received Date 11/4/2002 SITE ADDRESS: 123 FIR CIR Issue Date 11/5/2002 PORT HADLOCK, 98339 APPLICANT: SAMMIE K PARKER PHONE: (360)385-2668 123 FIR CIR PORT HADLOCK WA 98339-9592 33 SUBDIVISION: BISHOP ACRES Block: Lot: PARCEL NUMBER: 932300033 Section: 2 Township: 29N 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, SAMMIE K PARKER PHONE: (360)385-2668 if different: 123 FIR CIR PORT HADLOCK WA 98339-9592 PROJECT DESCRIPTION: PROPANE TANK, HEAT STOVE & PIPE 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 11/5/2003. REQUIRED INSPECTIONS: [ ] Tank/Line/Appliance: [ FinalApproval: 0 It GA /416 # 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:\F_BLD_Permit_Propane.rpt 10/29/19 1 1 * BLD02-00647" UILDING PERMIT APPLICAOON Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD02-00647 Received Date: 11/4/2002 SITE ADDRESS: 123 FIR CIR PORT HADLOCK, 98339 OWNER: SAMMIE K PARKER PHONE: (360)385-2668 123 FIR CIR PORT HADLOCK WA 98339-9592 SUBDIVISION: BISHOP ACRES Block: PARCEL NUMBER: 932300033 Section: 2 Township: 29 N Range: 01 WLot: 33 CONTRACTOR: SUNSHINE PROPANE 10853 RHODY DR PHONE: 385-5797 PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2002 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION PROPANE TANK, HEAT STOVE & PIPE 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: CONST TYPE: GARAGE: SHORELINE: DECK: SETBACK: SEWAGE DISPOSAL: BANK HEIGHT: WATER SYSTEM: BEDROOMS: BATHROOMS: PARCEL TAGS: YES NO STORMWATER: YES NO AREA Exist: Exist: Wetland Prop: Prop: Erosion 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 11/04/02 51292 Total: $47.00 IIIK EFFCOUNTYWA PH: 379-4450 JEFFERSON COMMUNl�EVELOPMENT,621 SHERIDAN ST,PORT TOWN 98368 (360) INSTALLATION PERMIT APPLICATION MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION Underground PROPANE TANK* /Above Ground PROPANE TANK I HEAT STOVE HOT WATER TANK WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE OTHER(Please Specify) ('}/)--k--- 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): I ) 3 I /2 c-1rZCt_ !D ,, I- 1- - 1419-19 LD C-k__ ZIP 9 DIGIT PARCEL ID NUMBER 13)- - J 0 o - 0 3 3 Legal Description: Subdivision Name Block Lot(s) Section Township North, Range WM APPLICANT (--)A-.7, .! F S4.11.)r)-, e -' (' lam-✓ PHONE 3 8,S-^ 2 4 MAILING ADDRESS S ZIP PROPERTY OWNER 4- i C/1"`2-- PHONE MAILING ADDRESS / ZIP frill PROPANE CONTRACTOR Quality Energy Services Since 1980 _ PHONE IF 10853 Rhody Dr.Hadlock,WA 98339 � (360)385-5797 or 683-4010 MAILING ADDRESS_ p, ' www.sunshinepropane.com 1 ZIP STATE LICENSE# SLt i Sttp7K O 77 4 to EXP. DATE l i/62-- FEDERAL I.D.# ct I - I(. 74 cP -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 app icant's property or structure shall be requested and shall occur during regular business hours. APPLICANT'S SIGNATURE C DATE /5 / _3/ / 6 2— FOR OFFICE USE ONLY BASE FEE RECEIPT# S I)51-2-- CONSISTENCY REVIEW CASH/CK# GI 13 6 TOTAL DATE H / L-) / 01-- *Underground Propane Tank applications require additional information to be submitted. Please contact our office at 360-379-4450 if the back of this application is blank. H:\HOM E\PLNCNTR\I NFOBLDG\FORMS\I NSTALL.DOC