HomeMy WebLinkAboutBLD2002-00688 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 #: BLD02-00688 Received Date 11/22/2002
SITE ADDRESS: 750 BLUE SKY DR Issue Date 11/22/2002
PORT TOWNSEND, 98368
APPLICANT: DAVID 0 SCHORES PHONE: (360)385-2791
TERRY SCHORES
PO BOX 357
PORT LUDLOW WA 98339
SUBDIVISION: DISCOVERY RIDGE DIV III Block: Lot:
PARCEL NUMBER: 001195107 Section: 19 Township: 30N Range: 01W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2004
OWNER, DAVID 0 SCHORES PHONE: (360)385-2791
if different: TERRY SCHORES
PO BOX 357
PORT LUDLOW WA 98339
PROJECT DESCRIPTION: PROPANE TANK, FURNACE & PIPE
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 11/22/2003.
REQUIRED INSPECTIONS:
[ ] CAppIiance: 'A' ! Vez
C:�o
[ ] FinalApproval: r" LO%'. t f 2-6--0
i v
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
i:\F_BLD_Permit_Propane.rpt 10/29/19
BLD02-00688
UILDING PERMIT APPLIC Ili ON Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00688 Received Date: 11/22/2002
SITE ADDRESS: 750 BLUE SKY DR
PORT TOWNSEND, 98368
OWNER: DAVID 0 SCHORES PHONE: (360)385-2791
TERRY SCHORES
PO BOX 357
PORT LUDLOW WA 98339
SUBDIVISION: DISCOVERY RIDGE DIV III Block: Lot:
PARCEL NUMBER: 001195107 Section: 19 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 DESCRIPTION PROPANE TANK, FURNACE & PIPE
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 11/22/02 51399
Total: $47.00
JEFFERSON COUNTY COMMU•DEVELOPMENT,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* Above Ground PROPANE TANK HEAT STOVE HOT WATER TANK
ty00DSTOVE FIREPLACE INSERT PELLET STAVE COOKING STOVE
OTHERW (Please Specify) - C/�JA�
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):
75-7) 8I S/4 7 ar•
e 1 , j Davie---hz ZIP 9 e-6
9 DIGIT PARCEL ID NUMBER CD I / I .S / 0
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range M
APPLICANT -P�i7i� W
PHONE 3 I'J a '
MAILING ADDRESS .. e..
.-
ZIP
i.
PROPERTY OWNER PHONE lr
MAILING ADDRESS t,
ZIP
CONTRACTOR �� SUNSHINE PROPANE
>�� Quality Energy Services Since 1980
10853 Rhody Dr.Hadlock,WA 98339
MAILING ADDRESS �) '� (360)385-5797 or 683-4010
www.sunshinepropane.com
STATE LICENSE# (94 P)J/7.`� R 6 7? Q
0 EXP. DATE /// o c!
FEDERAL I.D.# /7— /0 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 Jefferson County d 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 pr erty or structure shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE DATE C C/ 21/ 0 Z
6?
HDFgFtE I E pN____ f�/� -ECEIPT# 519��
BASE FEE
CONSISTENCY REVIEW NOV 2 2 2(02 I f ASH/CK# G( I 5,3
TOTAL G ',ATE I j /ZZ/ CJ Z.-
*Underground Propane Tank applications require additi r fcan ti 1wha*k*gf, pine ontact our office at 360-379-4450 if the back of
this application is blank.
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