HomeMy WebLinkAboutBLD2002-00648 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 #: BLD02-00648 Received Date 11/4/2002
SITE ADDRESS: 8196 HWY 20 Issue Date 11/5/2002
PORT TOWNSEND, 98368
APPLICANT: RUBY Y WISE PHONE: (360)385-0144
8196 STATE HIGHWAY 20
PORT TOWNSEND WA 98368-9764
T 4+
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 001213019 Section: 21 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, RUBY Y WISE PHONE: (360)385-0144
if different: 8196 STATE HIGHWAY 20
PORT TOWNSEND WA 98368-9764
PROJECT DESCRIPTION: PROPANE TANK, HEAT 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 11/5/2003.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[ ] nal!, proval: / ��� 7-NO 7r-
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
BUILDING PERMIT APPLICION BLD02-00648
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00648 Received Date: 11/4/2002
SITE ADDRESS: 8196 HWY 20
PORT TOWNSEND, 98368
OWNER: RUBY Y WISE PHONE: (360)385-0144
8196 STATE HIGHWAY 20
PORT TOWNSEND WA 98368-9764
SUBDIVISION: Block: Lot: T 4+
PARCEL NUMBER: 001213019 Section: 21 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 DESCRIPTION PROPANE TANK, HEAT 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:
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 11/04/02 51287
Total: $47.00
JEFFERSON COUNTY COMMUN•EVELOPMENT,621 SHERIDAN ST,PORT TOWN•D WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* L/A-I-ziove Ground PROPANE TANK HEAT STOVE HOT WATER TANK
WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE
BOTHER(Please Specify) c_a 6.14 e .
i 6
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): ri
Y 7 6 )(74- -)7 2-1()
/ / (d 6A- 'i't 0 Z-LIG-- ZIP 06(r.
/
9 DIGIT PARCEL ID NUMBER d D/ (3 - U/ 9'
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT le(tiG- CnJl/.l & PHONE 3 d--S- �Y
MAILING ADDRESS ..5l .
ZIP
PROPERTY OWNER PHONE //
MAILING ADDRESS //
tr
ZIP ``
�� SUNSHINE PROPANE
CONTRACTOR I �� Quality Energy Services Since 1980 PHONE
10853 Rhody Dr. Hadlock,WA 98339
MAILING ADDRESS iv, 'i (360)385-5797 or 683-4010
4
www.sunshinepropane.com
ZIP
STATE LICENSE# _S 61 /7,}/7 o,,A. O 77 CD/7 EXP.DATE i f/E 7_„__.--
FEDERAL I.D.# 7/ — /07f ,f'S"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 o the applicant's property or structure shall be requested and shall occur during regular business hours.
APPLICANT'S SIGNATURE ` / DATE /O / -Jr' / 2--
O sFigE 4E8Nry (L 1
BASE FEE �i//�(s �,2ECEIPT# 51 2S -4
CONSISTENCY REVIEW NOV - 4 ���� � I/ pASH/CK# 134
TOTAL } )DATE I 1 / L1 / C52--
*Underground Propane Tank applications require addi4ron"al-4nft ton to be'submitted. Please contact our office at 360-379-4450 if the back of
this application is blank.
H:\HOM E\PLN CNTR\I N FO B LDG\F ORMS\I N STALL.D OC