HomeMy WebLinkAboutBLD2002-00649 0 6
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 #: BLD02-00649 Received Date 11/4/2002
SITE ADDRESS: 780 ARCADIA WEST Issue Date 11/5/2002
PORT TOWNSEND, 98368
APPLICANT: MICHAEL L KUNZ PHONE: (360)385-6300
CYNTHIA ANN KUNZ
780 ARCADIA W
PORT TOWNSEND WA 98368-9616 T 43
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 001171023 Section: 17 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, MICHAEL L KUNZ PHONE: (360)385-6300
if different: CYNTHIA ANN KUNZ
780 ARCADIA W
PORT TOWNSEND WA 98368-9616
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:
[ ] ank/Lme/Applian --: ..,. /� e—O 2
[ 9- FinalApproval: rf7 K' . 42 —c3
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_Pe rm it_Propane.rpt 10/29/19
•.3UILDING PERMIT APPLIC .JN BLD02-00649
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00649 Received Date: 11/4/2002
SITE ADDRESS: 780 ARCADIA WEST
PORT TOWNSEND, 98368
OWNER: MICHAEL L KUNZ PHONE: (360)385-6300
CYNTHIA ANN KUNZ
780 ARCADIA W
PORT TOWNSEND WA 98368-9616
SUBDIVISION: Block: Lot: T 43
PARCEL NUMBER: 001171023 Section: 17 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 & PIPING
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION
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 11/04/02 51292
Total: $47.00
1/%6
- JEFFERSON COUNTY COMMUNIOEVELOPMENT,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 EAT STOVE HOT WATER TANK
WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE
OTHER(Please Specify) Go-
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):
�8 -) dA s�.
P i ( OGtir)-1 ZIP 9Q76C
9 DIGIT PARCEL ID NUMBER 0 O ( /
Legal Description:
Subdivision Name Block Lot(s)
Section Township W
J -)North, Range M
APPLICANT hf� ��n /i— PHONE . 6-5
/�6 ( dZ
MAILING ADDRESS _5L
ZIP
/1
PROPERTY OWNER PHONE
MAILING ADDRESS /r
ZIP
SUNSHINE PROPANE
CONTRACTOR _ Quality Energy Services Since 1980
10853 Rhody Dr. Hadlock,WA 98339 PHONE
(360)385-5797 or 683-4010
MAILING ADDRESS_ Ili I
www.sunshinepropane.com
ZIP
STATE LICENSE# Sc(/,S t * 07 7 i f EXP. DATE
FEDERAL I.D.# /0 7�/ CF. 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 Je rson 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 t applicant's property or structure shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE r--1"�^ DATE // / / 0
FOR OFFICE USE ONLY
BASE FEE RECEIPT# 5 1'19 CONSISTENCY REVIEW CASH/CK# q 13
TOTAL DATE I I. /
*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.
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