HomeMy WebLinkAboutBLD2003-00027 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#: BLD03-00027 Received Date 1/13/2003
SITE ADDRESS: 685 LUDLOW BAY RD Issue Date 1/14/2003
PORT LUDLOW, 98365
APPLICANT: DWIGHT F HAUPTMAN TRSTEE PHONE: (360)437-8097
MARIANNE D P HAUPTMAN TRS
685 LUDLOW BAY RD
PORT LUDLOW WA 98365 6
SUBDIVISION: LUDLOW BEACH TRS 2 Block: Lot:
PARCEL NUMBER: 969000006 Section: 16 Township: 28N Range: 01 E
CONTRACTOR: EMERALD HEARTH AND HOME PHONE: (360)779-7567
20714 SR 305
POULSBO WA 98370
Contractor's License EMERAHH001OL Expires 9/8/2004
OWNER, DWIGHT F HAUPTMAN TRSTEE PHONE: (360)437-8097
if different: MARIANNE D P HAUPTMAN TRS
685 LUDLOW BAY RD
PORT LUDLOW WA 98365
PROJECT DESCRIPTION: 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 1/14/2004.
REQUIRED INSPECTIONS:
[� ,pp Tank/Line lianc . i� '� KCEpL,4
[ FinalApproval: 40x �ror /30 G3
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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 APPLIC•ON BLD03-00027
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00027 Received Date: 1/13/2003
SITE ADDRESS: 685 LUDLOW BAY RD
PORT LUDLOW, 98365
OWNER: DWIGHT F HAUPTMAN TRSTEE PHONE: (360)437-8097
MARIANNE D P HAUPTMAN TRS
685 LUDLOW BAY RD
PORT LUDLOW WA 98365
SUBDIVISION: LUDLOW BEACH TRS 2 Block: Lot: 6
PARCEL NUMBER: 969000006 Section: 16 Township: 28 N Range: 01 E
CONTRACTOR: EMERALD HEARTH AND HOME PHONE: (360)779-7567
20714 SR 305
POULSBO WA 98370
Contractor's License EMERAHH001OL Expires 9/8/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI` 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:
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 01/13/03 52883
Total: $47.00
' - JEFFERSON COUNTY COMMUN.EVELOPMENT,621 SHERIDAN ST,PORT TOWD WA 98368 PH: (360)379-4450
INSTALTION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TOI THIS INSTALLATIONLA
Underground PROPANE TANK* Above Ground PROPANE TANK HEAT STOVE HOT WATER TANK
WOODSTOVE X 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):
til4S LK Ibl9w q?,V71 �a•6a
?el�.\ LMC 1,W Li,.114% ZIP t 2)140Sr
9 DIGIT PARCEL ID NUMBER I1/'i O00001,
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT '.. )t.../\���\ c-\�t1��"c,M igrJ PHONE ZG-ti - 4 31-S o \
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MAILING ADDRESS sc 6.1a.A.(ek. %A-) i-A
`eb VS- (....t..Clv w (n..)y �t 4\ ZIP l ica 1•r- `'
PROPERTY OWNER PHONE 3 G0 ^ (I ,1" to 91
MAILING ADDRESS 14" e S WNC..tw
ZIP
CONTRACTOR 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' • •f entry to Jefferson County and it's employees, representatives or agents for the purpose of application review and any
required later inspections. Access an !. of entry to t pplica t' pro ert or structure shall be requested and shall occur during regular business hours.
APPLICANT'S SIGNATURE / 4,1� DATE I / /1 / 03
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OFFICE USE ONLY
BASE FEE q ' RECEIPT# 15-2-Op
S 3
CONSISTENCY REVIEW -7 CASH/CK# 5 t 9 2
TOTAL '? _ Ub DATE I / 13 / 03
*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*
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