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HomeMy WebLinkAboutBLD2003-00009 • • , 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 #: BLD03-00009 Received Date 1/8/2003 SITE ADDRESS: 221 POND RD Issue Date 1/8/2003 PORT TOWNSEND, 98368 APPLICANT: WILLIAM G WOLF PHONE: 221 POND RD PORT TOWNSEND WA 983689664 SUBDIVISION: CAINE SHORT PLAT Block: Lot: PARCEL NUMBER: 002121020 Section: 12 Township: 30N Range: 02W CONTRACTOR: OWNER, WILLIAM G WOLF PHONE: (360)385-1381 if different: 221 POND RD PORT TOWNSEND WA 983689664 PROJECT DESCRIPTION LP BOILER AND INDIRECT HOT WATER MAKER 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 01/08/2004. REQUIRED INSPECTIONS: [ j' Tank/Line nc/Applia_ e: r [ I` FinalApproval: 1.:^› I -0-7 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 1:\F_BLD_Permit_Propane.rpt 10/29/19 • BUILDI BLD03-00009NG PERMIT APPLICATION Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD03-00009 Received Date: 1/8/2003 SITE ADDRESS: 221 POND RD PORT TOWNSEND, 98368 OWNER: WILLIAM G WOLF PHONE: 221 POND RD PORT TOWNSEND WA 983689664 SUBDIVISION: CAINE SHORT PLAT Block: Lot: PARCEL NUMBER: 002121020 Section: 12 Township: 30 N Range: 02 W CONTRACTOR: PHONE: PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIO LP BOILER AND INDIRECT HOT WATER MAKER INSTALLATION 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: 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 Seismic Streams Prop: Prop: Flood Way Floodplain Total: Total: F&W Landslide Routing Date: Shoreline Aquifer Forest: Commercial Rural Proximity Plat Conditions Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $47.00 PRB 01/08/03 51548 Total: $47.00 JEFFERSON COUNTY COMMUN•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) P, / for �/J/✓1/71e; ai, ` �' C"r,,,7'' 7-7(1,.eV 07 , r%7,� Is this appliance(htg stove, hot water tank,furnace,etc.)to be installed in a Manufactured/Mobile Horn YES NO SITE ADDRESS(911#/Road Name): P-)rit /(juA1 Sty /, f.e.M. ZIP � � 9 DIGIT PARCEL ID NUMBER 00 2 12--1 Q2.A Legal Description: Subdivision Name Block Lot(s) Section Township North, Range WM APPLICANT _L/) � / / PHONE MAILING ADDRESS /"',0. -&)(;�r 7 Y) ) (� )'7 ' /i7 �C ) ) �!zeiA-- ZIP �CP4 (� PROPERTY OWNER (°�(II/�_-�.// )e-7 1'}(' �/� PHONR--- -4 MAILING ADDRESS / �Py.z4)/�w; �/ ��1.�./a( v 6 /)4 - ZIP 7k � ` / CONTRACTOR <1/_iii/��t✓cP.. / -79-7f'%''-4° - /l.7" - PHONE- / Gee/ MAILING ADDRESS /- ' , L1(-�X 997 c./ ) 7/e: 77 '70 l ..)/ ` ZIP .� //4/ STATE LICENSE# S.n�2/15/fr�.>( /2L• EXP.DATE O9 '/6'l�"�" FEDERAL I.D.# 9' /( ,U'( ' 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 anddrr' ht of entry to the appl' ant's operty or stru ture s e requested and shall occur during regular business hours. APPLICANT'S SIGNATURE' //Jj)G,G� ,�r DATE / / d' I (�,Y BASE FEE ifr? FOR OFFICE USE ONLY RECEIPT# �cI-s2L q- CONSISTENCY REVIEW CASH/CK# 37 "✓ TOTAL 47©� DATE �/ U '3 *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. IIIIIIIII0 H:\HOME\PLNCNTR\INFOBLDG\FORMS\INSTALL.DOC