HomeMy WebLinkAboutBLD2002-00708 •
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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#: BLD02-00708 Received Date 12/2/2002
SITE ADDRESS: 82 MONTGOMERY LN Issue Date 12/3/2002
PORT LUDLOW, 98365
APPLICANT: ROBERT L BLAIR PHONE: (307)353-2582
JUDITH A BLAIR
PO BOX 135
DRIGGS ID 83422-0135 2
SUBDIVISION: PORT LUDLOW NO 2 AREA 1 Block: Lot:
PARCEL NUMBER: 990600102 Section: 9 Township: 28N Range: 01 E
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 9/6/2004
OWNER, ROBERT L BLAIR PHONE: (307)353-2582
if different: JUDITH A BLAIR
PO BOX 135
DRIGGS ID 83422-0135
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 12/3/2003.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[ "] FinalApproval: 77 1 /A /z�,4/OZ I')
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
7
•UILDING PERMIT APPLICAON BLD02-00708
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00708 Received Date: 12/2/2002
SITE ADDRESS: 82 MONTGOMERY LN
PORT LUDLOW, 98365
OWNER: ROBERT L BLAIR PHONE: (307)353-2582
JUDITH A BLAIR
PO BOX135
DRIGGS ID3 83422-0135
SUBDIVISION: PORT LUDLOW NO 2 AREA 1 Block: Lot: 2
PARCEL NUMBER: 990600102 Section: 9 Township: 28 N Range: 01 E
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 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:
CONST TYPE: OTHER:
GARAGE: SHORELINE:
CONST TYPE: 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 12/02/02 51468
Total: $47.00
♦ .t
JEFFERSON COUNTY COMMUJEVELOPMENT,621 SHERIDAN ST,PORT TOWIID WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* N Above Ground PROPANE TANK: HEAT STOVE HOT WATER TANK
WOODSTOVE N FIREPLACE INSERT / 1 PELLET STOVE COOKING STOVE �^
OTHER(Please Specify) � 7 �-('7/)-A)e- Cbt, 1&f t�fli5W\ � C� --St. Ctiki EERY
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):
Vobk. ,� r '
N O:LR Lon Lo ZIP -t t�.� 6 �r
9 DIGIT PARCEL ID NUMBER - (OUO • /0).
Legal Description: 66
Subdivision Name D _ i�j,p t-t1 Mora-In (6 Block Lot(s)
^Sectio-nq_ Township North, Range NM
APPLICANT �C�LJ 1 Pi CH PHONE O7_,S--3" C > _
MAILING ADDRESS e`0 1g0K.... 13]
D 176G ZIP 2V'
PROPERTY OWNER P.1 '�C'1ri- 2lei / r PHONE
MAILING ADDRESS g+'
ZIP
CONTRACTOR C C 1
PHONE
MAILING ADDRESS
ZIP
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 an ht of entry to Jefferson and it's employees, representatives or agents for the purpose of application review and any
required later inspections. Access a 1 r. ht o ntry to he applica Co,s o erty or structure shall be requested and shall occur during regular business hours.
APPLICANT'S SIGNATURE
DATE7 7 /6"'GL)/ L--
( 1� FOR OFFICE USE ONLY
H ��
BASE FEE RECEIPT# •,r•�1
CONSISTENCY REVIEW CASH/CK# Gg
TOTAL -1 •t5 D �,� C1ATE R I a. /I
.� 4 V La
Underground Propane Tank applications require additional in' io o s d. I OVER
Please contact our office at 360-379-4450 if the back of this appl per,-`:`_._ __
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DEPT. OF COMMUNITY DEVELOPMENT ,