HomeMy WebLinkAboutBLD2003-00021 i I
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#: BLD03-00021 Received Date 1/13/2003
SITE ADDRESS: 50 KELLER LN Issue Date 1/13/2003
PORT LUDLOW, 98365
APPLICANT: RICHARD F CAMPBELL PHONE:
ROSEMARY P CAMPBELL
50 KELLER LN
PORT LUDLOW WA 98365
SUBDIVISION: PORT LUDLOW NO 2 AREA 3 Block: Lot:
PARCEL NUMBER: 990600302 Section: 9 Township: 28N Range: 01E
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPI983O6 Expires 09/26/2004
OWNER, RICHARD F CAMPBELL PHONE:
if different: ROSEMARY P CAMPBELL
50 KELLER LN
PORT LUDLOW WA 98365
PROJECT DESCRIPTION ABOVE GROUND PROPANE TANK, PROPANE PIPING &
FIREPLACE INSERT
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 01/13/2004.
REQUIRED INSPECTIONS:
[„1 Tank/Line/Appliance: ®g GJ 6py/� LIDAs i /s�a3
i
[w] FinalApproval: (9 e� 0.030,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
is\F_BLD_Permit_Propane.rpt 10/29/19
•UILDING PERMIT APPLICA N
BLD03-000 Review Type:2 11
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD03-00021 Received Date: 1/13/2003
SITE ADDRESS: 50 KELLER LN
PORT LUDLOW, 98365
OWNER: RICHARD F CAMPBELL PHONE:
ROSEMARY P CAMPBELL
50 KELLER LN
PORT LUDLOW WA 98365
SUBDIVISION: PORT LUDLOW NO 2 AREA 3 Block: Lot:
PARCEL NUMBER: 990600302 Section: 9 Township: 28 N Range: 01 E
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPI983O6 Expires 09/26/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIO ABOVE GROUND PROPANE TANK, PROPANE PIPING & FIREPLACE
INSERT
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:
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
Prop: Prop: Seismic Streams
Total: Total: Flood Way Floodplain
F&W Landslide
Routing Date: L (� I D 3 Shoreline Aquifer
Forest: Commercial Rural
Proximity Plat Conditions
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 ZAN 01/13/03 52831
Total: $47.00
JEFFERSON COUNTY COMMUNI•VELOPMENT,621 SHERIDAN ST,PORT TOWNS•WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* k Above Ground PROPANE TANK HEAT STOVE HOT WATER TANK
vw4tcta
WOODSTOVE ;' FIREPLACE INSERT PELLET STOVE COOKING STOVE
OTHER(Please Specify) C
Is this appliance(htg stove, hot water tank,furnace, etc.)to be installed in a Manufactured/Mobile Home?
YES V NO
SITE ADDRESS(911#/Road Name):
_.5U �6u.C:ie L.AA'&
/ "/`, > „ f-_ L. 0L.( ,, s ZIP
9 DIGIT PARCEL ID NUMBER 990 r/.V0 '30 2-
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT (V/e/ffrR /�(567)1 y ( Yg L/_ PHONE J(�i `fj_. / - /C
MAILING ADDRESS 5 IS-jct.- / ,'9ii
Peie r I- c.)p L 44J It)A- ZIP C/ Q .3 6 S
PROPERTY OWNER !�/C/ .4 b 'l0,3
L 0,3 y r 6f` I//,7,GL, PHONE
MAILING ADDRESS ,6 ) G L e ie 1-47U ems/
t/ik G-. ',6 z_Ju__) / ZIP � �
CONTRACTOR , 2 C 9AJ1T4/AJ / 2I. / l/}/�// 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 rig of entry to the applicant's roperty or structure shall be requested and shall occur during regular business hours.
APPLICANT'S SIGNATURE 19'-e-P-,iLCLf'��
J `���-�� DATE / / / 3 / C% 73
y7
l5DR OFFICE USE ONLY )
BASE FEE ' RECEIPT# VSpZ.E3 /
CONSISTENCY REVIEW ^-� (P CASH/CK# Ss" ' 2
TOTAL LI /" DATE / //3 / 6
*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. EMIlk
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