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HomeMy WebLinkAboutBLD2003-00010 • • 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 #: BLD03-00010 Received Date 1/8/2003 SITE ADDRESS: 80 BAYVIEW AEI. Issue Date 1/8/2003 BRINNON, 98320 APPLICANT: QUENTON EDDS PHONE: 80 BAYVIEW LN BRINNON WA 98320 5 SUBDIVISION: OLYMPIC CANAL ADDITION 3 Block: 5 Lot: PARCEL NUMBER: 980700504 Section: 21 Township: 25N Range: 02W CONTRACTOR: FERRELLGAS PHONE: 1-888-933-7735 PO BOX 67 HOODSPORT WA 98548 Contractor's License FERRELPO55LH Expires 8/1/2004 OWNER, if different: rid/J'k�L n i !�. Ski'' .S4.�rC-rt PROJECT DESCRIPTION: HEAT STOVE IN ALLATION 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 1/8/2004. REQUIRED INSPECTIONS: [ Tank/Line/Appliance: IS—O 3 [ FinalApproval: -6 '03 D'e---- 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 S303UILDING PERMIT APPLIC BLD03-00010 ON Re0001 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD03-00010 Received Date: 1/8/2003 SITE ADDRESS: 80 BAYVIEW At BRINNON, 98320 OWNER: GAR` -Y DUNLAP gl-/CQs7©M ..-flflS PHONE: MARIAN iE DUN AP 80 BAYVIEW LN _ f30 OtUuli, (AA-cis?' 20 SUBDIVISION: OLYMPIC CANAL ADDITION 3 Block: 5 Lot: 5 PARCEL NUMBER: 980700504 Section: 21 Township: 25 N Range: 02 W CONTRACTOR: FERRELLGAS PHONE: 1-888-933-7735 PO BOX 67 HOODSPORT WA 98548 Contractor's License FERRELPO55LH Expires 8/1/2004 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP HEAT STOVE 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: 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 01/08/03 52869 Total: $47.00 JEFFERSON COUNTY COMMUI.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 4` ' 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): 'C' B. l z7/107 �-7''/ c,J //V i'/P c1 t/:, , v ��il /ic: I' / ZIP 9 ' 3 2 C 9 DIGIT PARCEL ID NUMBER Legal Description: Subdivision Name Block Lot(s) Section Township North, Range WM APPLICANT PHONE MAILING ADDRESS K j� (� ZIP PROPERTY OWNER(` I L f )7T %L) . I0D S PHONE MAILING ADDRESS;'S C A2y171 L ,cil f//_- /ry C� C' ). /, r)A-7 C- / / /R17L ZIP / 3 Z C CONTRACTOR ' l �?y Z PHONE A.G j')-7/A ''i MAILING ADDRESS �(,-, C A 7 hi / - ZIP 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 nd right of entry to the applicant's property or structure shall be requested and shall occur during regular business hours. APPLICANT'S SIGNATURE)! .r'��-r. .-' ' DATE / / BASE FEE Uq -0't FOR OFFICE USE ONLY RECEIPT# (c( )1 CONSISTENCY REVIEW CASH/CK# TOTAL LI- - en) DATE / /Q3 *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. H:\HOME\PLNCNTR\I NFOBLDG\FORMS\INSTALL.DOC