HomeMy WebLinkAboutBLD2002-00675 •
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 #: BLD02-00675 Received Date 11/12/2002
SITE ADDRESS: 70 MARINER PL Issue Date 11/15/2002
PORT LUDLOW, 98365
APPLICANT: ROBERT L AZEN TRUSTEE PHONE: (360)437-9677
CYPRESS COLLEGE SEM
70 MARINER PL
PORT LUDLOW WA 98365 4
SUBDIVISION: BAYVIEW VILLAGE DIV 2 Block: Lot:
PARCEL NUMBER: 931900004 Section: 16 Township: 28N Range: 01 E
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2002
OWNER, ROBERT L AZEN TRUSTEE PHONE: (360)437-9677
if different: CYPRESS COLLEGE SEM
70 MARINER PL
PORT LUDLOW WA 98365
PROJECT DESCRIPTION: PROPANE TANK, INSERT& 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 11/15/2003.
REQUIRED INSPECTIONS:
[ . Tank/Line/Appliance: '' -�',k
[ l'/ ulalApprova : e.- o
/-4k/ t90 -
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
.UILDING PERMIT APPLICAION B RDOe 00w 6e75
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00675 Received Date: 11/12/2002
SITE ADDRESS: 70 MARINER PL
PORT LUDLOW, 98365
OWNER: ROBERT L AZEN TRUSTEE PHONE: (360)437-9677
CYPRESS COLLEGE SEM
70 MARINER PL
PORT LUDLOW WA 98365
SUBDIVISION: BAYVIEW VILLAGE DIV 2 Block: Lot: 4
PARCEL NUMBER: 931900004 Section: 16 Township: 28 N Range: 01 E
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 DESCRIPTIOD PROPANE TANK, INSERT & 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 11/12/02 51366
Total: $47.00
JEFFERSON COUNTY COMMUN.EVELOPMENT,621 SHERIDAN ST,PORT TOWD WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* V Above Ground PROPANE TANK HEAT STOVE HOT WATER TANK
WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE
OTHER(Please Specify) 1 t,f
Is this appliance(htg hot water tank,furnace,etc.)to be installed in a Manufactured/Mobile Home?
YES NO
SITE ADDRESS(911#/Road Name):
70 i— Ic'f .ems
P- ti,teg o-i") G✓�- ZIP 9op .36,_S
9 DIGIT PARCEL ID NUMBER q 3 ( 9c 00 iL
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range W
—7 f� M
APPLICANT /� T< / 192� PHONE &'3 l / 6 7 7
MAILING ADDRESS C�
ZIP
r
PROPERTY OWNER j lt—c c.-- PHONE i
c!
MAILING ADDRESS
ZIP
CONTRACTOR _ Ir.I� SUNSHINE PROPANE _ PHONE
— �; Quality Energy Services Since 1980
MAILING ADDRESSIF 10853 Rhody Dr.Hadlock,WA 98339
IF/ 'S , (360)385-5797 or 683-4010 _ ZIP
www.sunshinepropane.com STATE LICENSE# _S414- ')Sff-n-N(E 077 ( P EXP. DATE i//C 4/
FEDERAL I.D.# /l 1079811
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 t the applicant's property or structure shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE ( 1 I DATE // / / 0Z
`'Ey F ...___ "� _V E 2,
d
BASE FEE PT#
CONSISTENCY REVIEW NOV 7 2 2002 CK#
TOTAL W DATE / /
.
*Underground Propane Tank applications require additional . t-1 . idn t6beG9u m Pt 't r ct our office at 360-379-4450 if the back of tt t l
this application is blank. _
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