HomeMy WebLinkAboutBLD2002-00718 • 0
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 #: BLD02-00718 Received Date 12/9/2002
SITE ADDRESS: 451 SENTINEL FIRS RD Issue Date 12/10/2002
PORT HADLOCK, 98339
APPLICANT: DAVID W CLARK PHONE: (360)437-0628
CARRIE C CLARK
PO BOX 762
PORT HADLOCK WA 98339-0762 T 42+
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 921193022 Section: 19 Township: 29N Range: 01E
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2004
OWNER, DAVID W CLARK PHONE: (360)437-0628
if different: CARRIE C CLARK
PO BOX 762
PORT HADLOCK WA 98339-0762
PROJECT DESCRIPTION: PROPANE TANK, GAS STOVE & 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 12/10/2003.
REQUIRED INSPECTIONS:
[ Tank/Line/Appliance: /,2 0 -0.7
[ `r` FinalApproval: vu Co,--e /,, 7 ,220-2-
7
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 APPLICIION BLD02-00718
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00718 Received Date: 12/9/2002
SITE ADDRESS: 451 SENTINEL FIRS RD
PORT HADLOCK, 98339
OWNER: DAVID W CLARK PHONE: (360)437-0628
CARRIE C CLARK
PO BOX 762
PORT HADLOCK WA 98339-0762
SUBDIVISION: Block: Lot: T 42+
PARCEL NUMBER: 921193022 Section: 19 Township: 29 N Range: 01 E
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr PROPANE TANK, GAS STOVE & PIPING
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 1997 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: 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 12/09/02 51483
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* L Above Ground PROPANE TANG L-'1 T STOVE HOT WATER TANK
WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE
1/OTHER(Please Specify) /Is this appliance (htg stove, hot water tank,furnace,etc.)to be installed in a Manufactured/Mobile Ho e?
YES NO
SITE ADDRESS(911 #/Road Name):
ZIP 9 U 3J
9 DIGIT PARCEL ID NUMBER [ ( if .! O v
Legal Description:
Subdivision Name Block Lot(s)
Section- Township North, Range J WM
APPLICANT Gl/� s Z r� ( /` PHONE �j 7 cv 2 0
MAILING ADDRESS ,/p✓O ,. �- 2 �— )
(T �� (�i°� ZIP 9 fJ 7
PROPERTY OWNER PHONE ( f�
MAILING ADDRESS f e
ZIP
CONTRACTOR SUNSHINE PROPANE , PHONE
Quality Energy Services Since 1980 —
MAILING ADDRESS 10853 Rhody Dr. Hadlock,WA 98339
(360)385-5797 or 683-4010
www.sunshinepropane.com
• ZIP
STATE LICENSE# �Gt sfi-p�O>67 7 QV EXP. DATE /,/
FEDERAL I.D.# 7/ l 07 dl°J 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 Jefferso ounty and it's employees, representatives or agents for the purpose of application review and any
required later inspections. Access and right of entry to the ap cant's property or structure shall be requested and shall occur during regular business hours.
APPLICANT'S SIGNATURE DATE /Z / Ur1 07
BASE FEE L _� FT E" E L I`� E EIPT# 5143
CONSISTENCY REVIEW jlj
' DEC _ 9 H/CK# L(o�
TOTAL I- 'DAT-
E P Zl
*Underground Propane Tank applications require additional irLigp1patip , �S�ff iii i Otease contact our office at 360-379-4450 if the back of
this application is blank. OF
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