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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 #: BLD03-00014 Received Date 1/9/2003
SITE ADDRESS: 213 SAN JUAN DR Issue Date 1/10/2003
PORT TOWNSEND, 98368
APPLICANT: PHIL BAUMGAERTNER PHONE: (360)340-3045
SHERRY BAUMGAERTNER
213 SAN JUAN DR
PORT TOWNSEND WA 98368 2
SUBDIVISION: CAPE GEORGE COLONY DIV 3 Block: 8 Lot:
PARCEL NUMBER: 938400802 Section: 12 Township: 30N Range: 02W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2004
OWNER, DOWNSTREAM INC A WA CORP PHONE:
if different: 10559 158TH AVE NE
REDMOND WA 98052
PROJECT DESCRIPTION: PROPANE TANK& HEAT STOVE 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 1/10/2004.
REQUIRED INSPECTIONS:
[ Tank/Line/Appliance: —%7 s-'
[:.} FinalApproval:Gla-a3-t,
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_Propa ne.rpt 10/29/19
°BUILDING PERMIT APPLICAION B RDOe 00w 0e14
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00014 Received Date: 1/9/2003
SITE ADDRESS: 213 SAN JUAN DR
PORT TOWNSEND, 98368
OWNER: PHIL BAUMGAERTNER PHONE: (360)340-3045
SHERRY BAUMGAERTNER
213 SAN JUAN DR
PORT TOWNSEND WA 98368
SUBDIVISION: CAPE GEORGE COLONY DIV 3 Block: 8 Lot: 2
PARCEL NUMBER: 938400802 Section: 12 Township: 30 N Range: 02 W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI PROPANE TANK & 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 01/09/03 52873
Total: $47.00
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JEFFERSON COUNTY COMMU•DEVELOPMENT,621 SHERIDAN ST,PORT TOW'D WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION ff�/J 1 11 ^ ✓- u I^` ' `6
Underground PROPANE TANK* Above Ground PROPANE TANK lx 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 L NO
SITE ADDRESS(911 #/Road Name): 0
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(, `i ZIP a
9 DIGIT PARCEL ID NUMBER ` 3 6 - !O 0 8 o �
Legal Description:
Subdivision Name Block Lot(s)
Section
/� Township North, Range VVM
APPLICANT Phis r ge-Yr 1 a Limit,. Lt e-r -t/ PHONE 3( 0 3 `/o - -J a ,,,s
MAILING ADDRESS cS(e
ZIP
PROPERTY OWNER Chi PHONE !(
MAILING ADDRESS
ZIP
CONTRACTOR p ift-ir
4+-...`.� PHONE 3?.I ' . 7 f 7
MAILING ADDRESS /0 o J .
ZIP /
STATE LICENSE# ZA,,._Jekr, O 7) Q ,7 e EXP. DATE WO
FEDERAL I.D.# 9/- /Z) 7f Pf 7
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 Jefferso County and it's employees, representatives or agents for the purpose of application review and any
required later inspections. Access and right of entry to the appl ant's property or structure shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE r''// DATE / / p / 43
FOR OFFICE USE ONLY
BASE FEE V 15 L [ j \ E ECEIPT#
CONSISTENCY REVIEW ASH/CK#
1
TOTAL JAN 9 2003 LOATE _/ /
*Underground Propane Tank applications require additional infckmation to be submitted._,P_.lease cOtact our office at 360-379-4450 if the back of
this application is blank. „_ • , f
DEPT. OF COMMUNITY DEVELOPMENT i
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