HomeMy WebLinkAboutBLD2002-00663 •
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 #: BLD02-00663 Received Date 11/8/2002
SITE ADDRESS: 605 ADELMA BEACH RD Issue Date 11/12/2002
PORT TOWNSEND, 98368
APPLICANT: JEREMY VANCE PHONE: (360)301-2903
46 VILLAGE WAY
PORT LUDLOW WA 98365
T 28+
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 901051020 Section: 5 Township: 29N Range: 01W
CONTRACTOR: CENEX SUPPLY MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 9/6/2004
OWNER, LAWRENCE J SOUTHMAYD PHONE: (360)379-1813
if different: KAREN SOUTHMAYD
605 ADELMA BEACH RD
PORT TOWNSEND WA 98368
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 11/12/2003.
REQUIRED INSPECTIONS:
[ ] ( Tank/Line/Appliance:
[ ] FinalApproval: 1 �� (,/ 42:2-
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_Perm it_Propane.rpt 10/29/19
.. .,. .
UILDI BLD
NG PERMIT APPLICAON Review02-00663
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00663 Received Date: 11/8/2002
SITE ADDRESS: 605 ADELMA BEACH RD
PORT TOWNSEND, 98368
OWNER: LAWRENCE J SOUTHMAYD PHONE: (360)379-1813
KAREN SOUTHMAYD
605 ADELMA BEACH RD
PORT TOWNSEND WA 98368
SUBDIVISION: Block: Lot: T 28+
PARCEL NUMBER: 901051020 Section: 5 Township: 29 N Range: 01 W
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 9/6/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION 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:
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 11/08/02 51356
Total: $47.00
JEFFERSON COUNTY COMMUN•EVELOPMENT,621 SHERIDAN ST,PORT TOWNOD 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 HEAT STOVE HOT WATER TANK
WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE
OTHER(Please Specify)
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):
GO 5 / - 'moo. e>c..0.41, a
pork- { O C 'I3 ItC ZIP R Cry 643
9 DIGIT PARCEL ID NUMBER 1 01 ' 05 I • o7-0
Legal Description:
Subdivision Name Block Lot(s)
Section l / Township North, Range WM
APPLICANT Serei y V U"hG�-. PHONE 360 30/ ct 03
MAILING ADDRESS li b VI I .1., W( P1 1Q 1,6 P r 1 t.vi-tp W
1 �, ,� U CJ ZIP 9�'-37�6j5
PROPERTY OWNER /1- / ,�ff:A) k OnaL r� PHONE 3 / { - 1 t 1
MAILING ADDRESS 6 0 Se.�fma- &,„a.ci.\ a.
ZIP
Mik i L-
CONTRACTOR 'V "LX. PHONE
MAILING ADDRESS
ZIP
STATE LICENSE# EXP.DATE
FEDERAL I.D.#
By signing the application form, the applicant/owner attests that the irlforfnatioh provided herein isete and correct to the best of their knowledge. Any material
falsehood or any omission of a material fact made by the applicant%owner Faith respect to this application iiigcket may result in this permit being null and void.
I further agree to save, indemnify and hold harmless Jefferson County againqMiliabilitieh,jtvilaRtints, court costs, reasonable attorney's fees and expenses which
may in any way accrue against Jefferson County as a result of or ii consequenNalit he gratin is perpi,Y„
i
I further agree to provide access and right of entry to Jefferson ounty and it's employees, representates or agents for the purpose of application review and any
required later inspections. Access and right of the applica pro or structure shall be rgquested and shall occur during regular business hours.
APPLICANT'S SIGNATURE .' DATE I , / 6 /a.)....
BASE FEE / 7
FOR OFFICE USE ONLY I �
RECEIPT#
CONSISTENCY REVIEW CASH/CK# -a,b
TOTAL _I DATE t ( / / 0)
*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. MMik
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