HomeMy WebLinkAboutBLD2002-00650 4 •
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 #: BLD02-00650 Received Date 11/4/2002
SITE ADDRESS: 194 PROSPECT AVE Issue Date 11/5/2002
PORT TOWNSEND, 98368
APPLICANT: RICHARD L PORSCH PHONE: (360)385-2765
PO BOX 323
PORT HADLOCK WA 98339
1
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 001342021 Section: 34 Township: 30N Range: 01W
CONTRACTOR: MOUNTAIN PROPANE LLC PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPL994BH Expires 12/14/2002
OWNER, RICHARD L PORSCH PHONE: (360)385-2765
if different: PO BOX 323
PORT HADLOCK WA 98339
PROJECT DESCRIPTION: PROPANE TANK 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 11/5/2003.
REQUIRED INSPECTIONS:
i
[ ] Tank/Lin /Appliance: '< /24 72- /
[ ] FinalApproval: v( e/ /0.0L
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
OBUIL DI BLD02-00650NG PERMIT APPLICON Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00650 Received Date: 11/4/2002
SITE ADDRESS: 194 PROSPECT AVE
PORT TOWNSEND, 98368
OWNER: RICHARD L PORSCH PHONE: (360)385-2765
PO BOX 323
PORT HADLOCK WA 98339
SUBDIVISION: Block: Lot: 1
PARCEL NUMBER: 001342021 Section: 34 Township: 30 N Range: 01 W
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 DESCRIPTIOt PROPANE TANK INSTALLATION
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: 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 51296
Total: $47.00
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JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNSEND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE /c. 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:
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/ / ZIP 9k 3 69 DIGIT PARCEL ID NUMBER �® ( — 3 q ?—0 ?/
Legal Description: ,, j� i� x'
Subdivision Name (1., ti ' `.3 , 7- e.-J S S. to Block Lot(s)
callf Section 3 7 Township j 0 North, Range 11
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APPLICANT R I C tt er P6,--5 C PHONE rr% ! -7 F S --Z- �6.5--
MAILING ADDRESS , 19(3,( 2 3 /U / /<]c%''C (( jJ k?
ZIP
PROPERTY OWNER 5 4)d/ -- PHONE
MAILING ADDRESS
ZIP
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CONTRACTOR � � �Y2�����' PHONE ��� — ��S —"?;PFC
MAILING ADDRESSy�— c 4 c.. £ , / �
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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.
APPLICANT SIGNATURE /r:✓�'/G� 4 O� DATE // �/ �Z_—
FOR OFFICF 11SF ON1 Y !
BASE FEE 0 U tE V ECEIPT# 5(2_9(,0
�IS `lASH/CK# 5 l O
TOTAL NOV 4 2002 I�.ATE (�/ / bZ-
H:\HOME\PLNCNTR\INFOBLDG\FORMS\INSTALL.DOC11/05/01 .3 1`:t-, . U li I Y I
DEPT. OF COMMUNITY DEVELOPMENT
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