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HomeMy WebLinkAboutBLD2002-00705 • • 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 #: BLD02-00705 Received Date 12/2/2002 SITE ADDRESS: 221 CUB RD Issue Date 12/3/2002 PORT TOWNSEND, 98368 APPLICANT: HOWARD A NIBECKER PHONE: PO BOX 86 CHIMACUM WA 98325-0086 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001321005 Section: 32 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, HOWARD A NIBECKER PHONE: if different: PO BOX 86 CHIMACUM WA 98325-0086 PROJECT DESCRIPTION: PROPANE TANK, PIPING & HOT WATER HEATER 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:ej/C '` /,2.5 6Z_ [ FinalApproval: t7" . /2-- -o 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 *BUILDING PERMIT APPLIC•ON BLRDOe 007705 w Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD02-00705 Received Date: 12/2/2002 SITE ADDRESS: 221 CUB RD PORT TOWNSEND, 98368 OWNER: HOWARD A NIBECKER PHONE: PO BOX 86 CHIMACUM WA 98325-0086 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001321005 Section: 32 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 11/17/2004 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION PROPANE TANK, PIPING & HOT WATER HEATER 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 12/02/02 51470 Total: $47.00 JEFFERSON COUNTY COMMUfEVELOPMENT,621 SHERIDAN ST,PORT TOWD WA 98368 PH: (360)379-4450 INSTALLATION PERMIT APPLICATION MARK ALL ITEMS BELOW THAT PERTAIN�TOTHIS INSTALLATION OT Underground PROPANE TANK* r Above Ground PROPANE TANK HEAT STOVE ' HOT WATER TANK WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE VOTHER(Please Specify)___ ,/p /4 W 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): z-Z ( c P l . i ZIP /CL-4 9 DIGIT PARCEL ID NUMBER ©0/ 3,. / o S Legal Description: Subdivision Name Block Lot(s) Section Township North, Range WM APPLICANT 74Z4.) (/ +C 0-- PHONE MAILING ADDRESS PD 6-try. ( 1 c ZIP l CP3 Z S PROPERTY OWNER ars241,0, PHONE MAILING ADDRESS ! / ZIP • SUNSHINE PROPANE CONTRACTOR Quality Energy Services Since 1980 PHONE 10853 Rhody Dr.Hadlock,WA 98339 MAILING ADDRESS (360)385-5797 or 683-4010 www.sunshinepropane.com • ZIP STATE LICENSE# ns p C•_ 077 Q p EXP.DATE ///o y FEDERAL I.D.# qi ^ /b 7 g Q f 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 and it's employees, representatives or agents for the purpose of application review and any required later inspections. Access and right of entry to th applicant's property or structure shall be requested and shall occur during regular business hours. APPLICANTS SIGNATURE Yy� DATE /( / --7 / OL ZEFC BASE FEE I C IL(�jJ EECEIPT#_, (� U 5 t Li 9-0 CONSISTENCY REVIEW DEC -2 ASH/CK# Ct[CO TOTAL DATE 12/ 2/ 02- *Underground Propane Tank applications require additions rrt3�l 4 O icontact our office at 360-379-4450 if the back of this application is blank. a H:\HOME\PLNCNTR\INFOBLDG\FORMS\I NSTALL.DOC