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HomeMy WebLinkAboutBLD2003-00011 f 411, 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 #: BLD03-00011 Received Date 1/8/2003 SITE ADDRESS: 121 CI TORE DR E ALDER.ST Issue Date 1/8/2003 PORT LUDLOW, 98365 APPLICANT: SHARON B MOORE PHONE: 947 1/2 S SHERIDAN AVE TACOMA WA 98405-3633 SUBDIVISION: PARADISE BAY ESTATES Block: Lot: PARCEL NUMBER: 983401014 Section: 23 Township: 28N Range: 01 E CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CENEXHS022NQ Expires 9/6/2004 OWNER, SHARON B MOORE PHONE: if different: 947 1/2 S SHERIDAN AVE TACOMA WA 98405-3633 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 1/8/2004. REQUIRED INSPECTIONS: [ ] r Tank/Line/Appliance: d‹ 0,4/6‘3� [ ] FinalApproval: 4‘/ AA7#4r �SSug' # , 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 03 UILDING PERMIT APPLICON BLD03-00011Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD03-00011 Received Date: 1/8/2003 SITE ADDRESS: 1 Lk 31 FORE DR E.Awe.- ST PORT LUDLOW, 98365 OWNER: SHARON B MOORE PHONE: 947 1/2 S SHERIDAN AVE TACOMA WA 98405-3633 SUBDIVISION: PARADISE BAY ESTATES Block: Lot: PARCEL NUMBER: 983401014 Section: 23 Township: 28 N Range: 01 E CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CENEXHS022NQ Expires 9/6/2004 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION 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: 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 52870 Total: $47.00 JEFFERSON COUNTY COMMUNDEVELOPMENT,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 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 Manufactured/Mobile Home? YES NO SITE ADDRESS(911 #/Road Name): - ,r, <�s' 6- 2 .L: ,cy. , '' ,5' 4 4 i v `� </ ZIP ��y� 9 DIGIT PARCEL ID NUMBER L-G 6 /, r / e)/"-c / Legal Description: Subdivision Name Block Lot(s) SectionW Township North, Range M r APPLICANT �j -) ,t}'e_©G� i9---e// / E PHONE MAILING ADDRESS J 'y T� 55' 7 ,5 2,/ch } t 7GL G e;.— -./ A- ` IJ ZIP PROPERTY OWNER . 5 z A7-f' '' PHONE MAILING ADDRESS ZIP CONTRACTOR (- • .rZ_ "t X PHONE ^ MAILING ADDRESS 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 and right of entry th 'plicant's propert r s ucture shall be requested and shall occur during regular business hours. APPLICANTS SIGNATURE -G ,` DATE / / FOR OFFICE USE ONLY BASE FEE L �" RECEIPT# CONSISTENCY REVIEW CASH/CK# '1 TOTAL " 1 • 5t) DATE _/ / *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. MIIII* H:\HOMERACNTR\INFOBLDGFORMS\INSTALL.DOC