HomeMy WebLinkAboutBLD2002-00727 4111b
UILDING PERMIT APPLICN BLD02-00727Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00727 Received Date: 12/13/2002
SITE ADDRESS: 787 OLELE POINT RD
PORT LUDLOW, 98365
OWNER: THOMAS J HERMSEN PHONE: (360)437-0656
BARBARA HERMSEN
787 OLELE POINT RD
PORT LUDLOW WA 98365-9474
SUBDIVISION: OLELE POINT Block: Lot: 10-15
PARCEL NUMBER: 977400008 Section: 28 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 BOILER
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 12/13/02 51498
Total: $47.00
1
• •
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 #: BLD02-00727 Received Date 12/13/2002
SITE ADDRESS: 787 OLELE POINT RD Issue Date 12/16/2002
PORT LUDLOW, 98365
APPLICANT: THOMAS J HERMSEN PHONE: (360)437-0656
BARBARA HERMSEN
787 OLELE POINT RD
PORT LUDLOW WA 98365-9474 10-15
SUBDIVISION: OLELE POINT Block: Lot:
PARCEL NUMBER: 977400008 Section: 28 Township: 29N 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
OWNER, THOMAS J HERMSEN PHONE: (360)437-0656
if different: BARBARA HERMSEN
787 OLELE POINT RD
PORT LUDLOW WA 98365-9474
PROJECT DESCRIPTION: BOILER
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 12/16/2003.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[ ] FinalApproval: )vZ 2.0 Off-
#,9
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
II
-- _°-_,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 TANIt_ 8°I L.
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(911O/e/e P�/Road Name): n
JP/ • 4-LL v&-c2 �J , C1 0ZIP ( d 34�1
9 DIGIT PARCEL ID NUMBER ! ( ( - goo - D0c?
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
4/3706STo
APPLICANT a-4, to �=,r z-. Wcii(s v- r— PHONE
MAILING ADDRESS J
ZIP
PROPERTY OWNER 3 `�h *-)- Wer-h--4-e-s_d PHONE
MAILING ADDRESS ,.,5
ZIP
CONTRACTOR ik,r'V- — 4 4.µ--, PHONE 3 Q S 57 ( 7
MAILING ADDRESS ! Off) k 5 DI-
P/ L ZIP 91337
STATE LICENSE# ,5 t/?fm C 077 Q P EXP. DATE l770 y
FEDERAL I.D.# 7/ - /O7 (q 9$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 tot a applicant's property or structure shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE (3fi DATE (1_-/ /)-/ O
FOR O liE CLl",,, II V 15
BASE FEE DECE I - >I 49
CONSISTENCY REVIEW 1r 1 3 AS # 9 (�
TOTAL DAT I F 13 /O��
Y
Underground Propane Tank applications require additional inforr itted,.-Please eontactvur office at 360-379-4450 if the back of
this application is blank.
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