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HomeMy WebLinkAboutBLD2002-00658 • i 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 #: BLD02-00658 Received Date 11/6/2002 SITE ADDRESS: 50 KEM ST Issue Date 11/6/2002 PORT HADLOCK, 98339 APPLICANT: DAVID G DEMPSEY PHONE: 50 KEM ST PORT HADLOCK WA 983399534 11-14 SUBDIVISION: CHALMER'S 2ND ADDITION Block: 8 Lot: PARCEL NUMBER: 942900812 Section: 3 Township: 29N Range: 01W CONTRACTOR: SUBURBAN PROPANE PHONE: 385-5096 P 0 BOX 989 PORT TOWNSEND WA 98368 Contractor's License SUBURPL044DA Expires 03/08/2003 OWNER, DAVID G DEMPSEY PHONE: if different: 50 KEM ST PORT HADLOCK WA 983399534 PROJECT DESCRIPTION GAS COOKING STOVE AND NEW GAS PIPING TO STOVE AND CLOTHES DRYER 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 11/06/2003. REQUIRED INSPECTIONS: [ ] Tank/Line/Appliance• (—t —0 'Z [ ] FinalApproval: O/ti d/� --/ /O Z 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_Propa ne.rpt 10/29/19 tUILDING PERMIT APPLICAtON BRDO2 Oyp6e 8 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD02-00658 Received Date: 11/6/2002 SITE ADDRESS: 50 KEM ST PORT HADLOCK, 98339 OWNER: DAVID G DEMPSEY PHONE: 50 KEM ST PORT HADLOCK WA 983399534 SUBDIVISION: CHALMER'S 2ND ADDITION Block: 8 Lot: 11-14 PARCEL NUMBER: 942900812 Section: 3 Township: 29 N Range: 01 W CONTRACTOR: SUBURBAN PROPANE PHONE: 385-5096 P 0 BOX 989 PORT TOWNSEND WA 98368 Contractor's License SUBURPL044DA Expires 03/08/2003 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIO GAS COOKING STOVE AND NEW GAS PIPING TO STOVE AND CLOTHES DRYER 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: 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 F&W Landslide Routing Date: Shoreline Aquifer Forest: Commercial Rural Proximity _ Plat Condition& Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $47.00 ZAN 11/06/02 51229 Total: $47.00 JEFFERSON COUNTY COMMU DEVELOPMENT,621 SHERIDAN ST,PORT TOWID WA 98368 PH: (360)379-4450 INSTALLATION PERMIT APPLICATION MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION Underground PROPANE TANK* x Above Ground PROPA ` � HEAT STOVE HOT WATER TANK WOODSTOVE FIREPLACE INSERT PELLET STOVE �I. COOKING STOVE OTHER(Please Specify) (r 0--5 4 30 i,n` 4e-, l� STo ve `ca c I -'-hes 10f7-e e-_ is this appliance(htg stove, hot water tank,furnace,etc.)to be installed in a Manufactured/Mobile Home? YES x NO SITE ADDRESS(911 #/Road Name): 5C KP Sf � `j r I 4__`I / ( . ) r ZIP / 9 DIGIT PARCEL ID NUMBER / Z / d© F/2 Legal Description: Subdivision Name Block Lot(s) Section Township North, Range WM APPLICANT C TtC: S y PHONE S O �--6 3 33 MAILING ADDRESS e f/V\ ,--k---/ 1-C 1 \ \ ccL / c_ ZIP qC") 3p PROPERTY OWNER / Y A-b.:!3 PHONE MAILING ADDRESS ZIP CONTRACTOR S,___ S ba Pr<Vct-`. PHONE CSC c�' C-K MAILING ADDRESS (� 7 R 4 �i"-) t rg,..)/1 S.e.)-,G4 / C--Aj f,Q y ZIP cT 3C STATE LICENSE# E U C .Vet_ 0 41 LI 10 f - EXP.DATE / d„3 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 entr to efferson County and it's employees, representatives or agents for the purpose of application review and any required later inspections. Access and right of ntr t the applicant's property or structure shall be requested and shall occur during regular business hours. APPLICANT'S SIGNATURE DATE I I / (� / © 2 F OFFICE USE ONLY 5-1 aa� BASE FEE RECEIPT# CONSISTENCY REVIEW - CASH/CK# it CO TOTAL -T 7' DATE (( / 6 / 02-• *Underground Propane Tank applications require additional information to be submitted. OVER Please contact our office at 360-379-4450 if the back of this application is blank. H:\HOME\PLNCNTR\INFOBLDG\FORMS\I NSTALL.DOC