HomeMy WebLinkAboutBLD2003-00013 • •
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 #: BLD03-00013 Received Date 1/10/2003
SITE ADDRESS: 474 SENTINAL FIRS RD Issue Date 1/10/2003
PORT HADLOCK, 98339
APPLICANT: CINDY L THOMPSON PHONE:
ERIC J MICHAELS
PO BOX 3
PORT HADLOCK WA 983390003 T 76
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 921193046
CONTRACTOR:
OWNER, CINDY L THOMPSON PHONE:
if different: ERIC J MICHAELS
PO BOX 3
PORT HADLOCK WA 983390003
PROJECT DESCRIPTION WOODSTOVE 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 01/10/2004.
REQUIRED INSPECTIONS: �JZiq#. j .e[ ] Tank/Line/Appliance: �!/ allig;) 0.06°,
[ ] FinalApproval: 2& --czer 4 n.Adi 4/Zs,O5 19/
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
OBUILDING PERMIT APPLIC•ON BLD03-00013
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00013 Received Date: 1/10/2003
SITE ADDRESS: 474 SENTINAL FIRS RD
PORT HADLOCK, 98339
OWNER: CINDY L THOMPSON PHONE:
ERIC J MICHAELS
PO BOX 3
PORT HADLOCK WA 983390003
SUBDIVISION: Block: Lot: T 76
PARCEL NUMBER: 921193046 Section: Township: Range:
CONTRACTOR: PHONE:
PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIO WOODSTOVE 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
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 01/10/03 51550
Total: $47.00
JEFFERSON COUNTY COMMUfDEVELOPMENT,621 SHERIDAN ST,PORT TOWD WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
UUn erground PROPANE TANK* Above Ground PROPANE TANK HEAT STOVE __HOT WATER TANK
V 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):
1-17q Sew (�ef 1—I4s
�J'J F'Vr4- (`; C�(odc ZIP I O
9 DIGIT PARCEL ID NUMBER `1 a i 4
Legal Description:
Subdivision Name Block Lot(s)
//�� Section /r__ Township North, Range WM
APPLICANT l_1tn/Ill I VIo vpccn rriC W((cAa (S PHONE 6137— OSO1
MAILING ADDRESS P 6 3CX 3 / 1
Pry- c tA(6(fc / II 1.&J6 ZIPW
PROPERTYONER ,1F1/X(.-{ i ylUyV sci'� C !Vi ((GI r'1 PHONE / ��5 Q
MAILING ADDRESS 1
ZIP
CONTRACTOR Odo11 e r S 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 ight of entry to the a licant's property or structure shall be requested and shall occur during regular business hours.
APPLICANT'S SIGNATURE on DATE / / /d / 03
47%FOR OFFICE USE ONLY !
BASE FEE RECEIPT# •y
CONSISTENCY REVIEW ,L�� CASH/CK# 4 l gg
TOTAL `�7�� DATE ( /V) / 103
*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.
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