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HomeMy WebLinkAboutBLD2002-00715 • 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 #: BLD02-00715 Received Date 12/6/2002 SITE ADDRESS: 234 SOMMERVIEW RD Issue Date 12/6/2002 PORT HADLOCK, 98339 APPLICANT: RICHARD L LOUTHAN PHONE: (360)379-8143 PAULA J LOUTHAN PO BOX 268 CHIMACUM WA 98325-0268 3 SUBDIVISION: SEAVIEW LAND CO INC SHORT PLAT Block: Lot: PARCEL NUMBER: 901034013 Section: 3 Township: 29N Range: 01W CONTRACTOR: MOUNTAIN PROPANE LLC PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTPL994BH Expires 12/14/2002 OWNER, RICHARD L LOUTHAN PHONE: (360)379-8143 if different: PAULA J LOUTHAN PO BOX 268 CHIMACUM WA 98325-0268 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 12/6/2003. REQUIRED INSPECTIONS: [ ( Tank/Line/Appliance: nK / �'SL. /off aZ [ ] FinalApproval: c-//06. i2 - 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 APPLICON BLD02-00715 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD02-00715 Received Date: 12/6/2002 SITE ADDRESS: 234 SOMMERVIEW RD PORT HADLOCK, 98339 OWNER: RICHARD L LOUTHAN PHONE: (360)379-8143 PAULA J LOUTHAN PO BOX 268 CHIMACUM WA 98325-0268 SUBDIVISION: SEAVIEW LAND CO INC SHORT PLAT Block: Lot: 3 PARCEL NUMBER: 901034013 Section: 3 Township: 29 N Range: 01 W CONTRACTOR: MOUNTAIN PROPANE LLC PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTPL994BH Expires 12/14/2002 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI' 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: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: 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 12/06/02 51481 Total: $47.00 JEFFERSON COUNTY COMMUN.EVELOPMENT,621 SHERIDAN ST,PORT TOWD WA 98368 PH: (360)379-4450 INSTALLATION PERMIT APPLICATION MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION � Se5nder round PROPANE TANK* Above Ground PROPANE TANK __HEAT STOVE HOT WATER TANK WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE OTHER(Please Specify) Is this appliance(htg stove, hot water tank,furnace,etc.)to be installed in a Manufactured/Mobile Home? YES NO SITE ADDRESS(911 #/Road Name): i .i3`f. So-fr��,1 ;LLB czo r,O 1 Nry\,,e1 Yr\. W f ZIP 9 S3 --- 9 DIGIT PARCEL ID NUMBER 9 o I 03 11 ©l 3 Legal Description: Subdivision Name Block Lot(s) Section Township North, Range WM APPLICANT W H ✓' PHONE 3`7` (a )LI 3 MAILING ADDRESS CO e)nA 2-6b �J l'Y\A Yr\. \ 1JA ZIP r'{3-3 2: PROPERTY OWNER A' PHONE MAILING ADDRESS • ZIP CONTRACTOR {r\L u N T/i)"J f-06'.A 6`S PHONE MAILING ADDRESS u G{ Y1�1 tot \o.4 LJU,A ZIP i��)�13 I STATE LICENSE# EXP.DATE FEDERAL I.D.# By signing the application form, the applicant/owner attests that the information provided herein is true and correct to the best of their knowledge. Any material falsehood or any omission of a material fact made by the applicant/owner with respect to this application packet may result in this permit being null and void. I further agree to save, indemnify and hold harmless Jefferson County against all liabilities,judgments, court costs, reasonable attorney's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and it's employees, representatives or agents for the purpose of application review and any required later inspections. Access and right/o ntry o the applicant's property or structure shall be requested and shall occur during regular business hours. APPLICANT'S SIGNATURE / � �\> DATE '2- / 4)6 d BASE FEE Lf1 -��R OFFICE USE ONLY RECEIPT#� rj!I-{$ 1 7> CONSISTENCY REVIEW `t CASH/CK# F3 t TOTAL -1-- •OD DATE !2-1 `o / oZ *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. EIM* H:\HOME\PLNCNTR\INFOBLDG\FORMS\I NSTALL.DOC