HomeMy WebLinkAboutBLD2002-00746 i •
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 #: BLD02-00746 Received Date 12/30/2002
SITE ADDRESS: 91 CEDAR DR Issue Date 12/31/2002
PORT TOWNSEND, 98368
APPLICANT: LAWRENCE D WHITE PHONE: (360)835-5705
LINDA L WHITE
2119 SE 396TH AVE
WASHOUGAL WA 98671-6606 49
SUBDIVISION: CAPE GEORGE VILLAGE DIV 3 Block: Lot:
PARCEL NUMBER: 940500048 Section: 13 Township: 30N Range: 02W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPI983O6 Expires 9/26/2004
OWNER, LAWRENCE D WHITE PHONE: (360)835-5705
if different: LINDA L WHITE
2119 SE 396TH AVE
WASHOUGAL WA 98671-6606
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 12/31/2003.
REQUIRED INSPECTIONS:
[ an m /Appliance: 11ifC /��'/6 a /
d a .q..,46. 2-...--...,/
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_B LD_Perm it_Propane.rpt 10/29/19
41kUILDING PERMIT APPLICAIN BLDOe 007746
Reviw Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00746 Received Date: 12/30/2002
SITE ADDRESS: 91 CEDAR DR
PORT TOWNSEND, 98368
OWNER: LAWRENCE D WHITE PHONE: (360)835-5705
LINDA L WHITE
2119 SE 396TH AVE
WASHOUGAL WA 98671-6606
SUBDIVISION: CAPE GEORGE VILLAGE DIV 3 Block: Lot: 49
PARCEL NUMBER: 940500048 Section: 13 Township: 30 N Range: 02 W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPI98306 Expires 9/26/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP 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 12/30/02 52749
Total: $47.00
JEFFERSON COUNTY COMMUNI•EVELOPMENT,621 SHERIDAN ST,PORT TOWN.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 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 Manufacture /Mo le Home?
YES NO
SITE ADDRESS(911#/Road Name): / ,
At
/'pe ✓Zd "2 (9i //j/ ZIP ,Y f 3 J
9 DIGIT PARCEL ID NUMBER - �I V 5 ��") o% &
Legal Description:
Subdivision Name C /�r'P e O/f�� (1///ije Block Lot(s)
Section Township North, Range �i WM
APPLICANT �A'GG>/cf7C C� � K//✓/ ` e PHONE �l.�a e S5 'of/�j (�►
MAILING ADDRESS �S ,�,�// // �LL f� /� C,� ci��`'e 36 5 5 Y%3 6
GIi S/(CC{ �7 C/ //�7`C ,( ZIP 7I 7/
PROPERTY OWNER /ni 46/7eG7(f'N D• GO/7 / L- PHONE
MAILING ADDRESS jZ/�l $C` 3 y'b
cA0 /4 L G�'�/,5./1. ZIP 1 7/
CONTRACTOR /19 ilk./JTL1/d'7 �/n6V /9f2(�—, PHONE aa ?Gr: _�i.S ,&
MAILING ADDRESS �( (G' f �j C��}////7 I/I4t c fi
11 i4(i Inc. l( 1V/ ZIP 9 32 8
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 righ of entry to the applicant's property or structure II be re ested and shall occur during regular business hours.
�
APPLICANTS SIGNATURE DATE /2-/ Jo / C t'
b 6OR OFFICE USE ONLY —7 </
BASE FEE y • RECEIPT# ✓ / 7
CONSISTENCY REVIEW CASH/CK# /L'�/ 76,C)
TOTAL - �'+1 • t7° DATE lea/3L/_Q_o`k
*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. 10111*
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