HomeMy WebLinkAboutBLD2003-00033 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 #: BLD03-00033 Received Date 1/16/2003
SITE ADDRESS: 31 FINCH LN Issue Date 1/16/2003
PORT LUDLOW, 98365
APPLICANT: DALE K FLODIN PHONE:
PO BOX 11293
BAINBRIDGE ISLAND WA 981105293
10
SUBDIVISION: BRIDGEHAVEN DIV 6 Block: Lot:
PARCEL NUMBER: 935400010 Section: 9 Township: 27N Range: 01 E
CONTRACTOR: SUBURBAN PROPANE PHONE: 385-5096
P 0 BOX 989
PORT TOWNSEND WA 98368
Contractor's License SUBURPL044DA Expires 03/08/2003
OWNER, DALE K FLODIN PHONE:
if different: PO BOX 11293
BAINBRIDGE ISLAND WA 981105293
PROJECT DESCRIPTION INSTALL PROPANE TANK AND HEATING STOVE
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 01/16/2004.
REQUIRED INSPECTIONS:
[ an.;aggi• .. - - 7L( z/I 63 Le) GortitZ/ens j
[� FinalApproval: OE 2/i1/Q " cOr 00-3,
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
00u1LDING PERMIT APPLIN
BLD03-00033
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00033 Received Date: 1/16/2003
SITE ADDRESS: 31 FINCH LN
PORT LUDLOW, 98365
OWNER: DALE K FLODIN PHONE:
PO BOX 11293
BAINBRIDGE ISLAND WA 981105293
SUBDIVISION: BRIDGEHAVEN DIV 6 Block: Lot: 10
PARCEL NUMBER: 935400010 Section: 9 Township: 27 N Range: 01 E
CONTRACTOR: SUBURBAN PROPANE PHONE: 385-5096
P 0 BOX 989
PORT TOWNSEND WA 98368
Contractor's License SUBURPL044DA Expires 03/08/2003
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIO INSTALL PROPANE TANK AND HEATING STOVE
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 1997 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: 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
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 01/16/03 52909
Total: $47.00
JEFFERSON COUNTY COMMVELOPMENT,621 SHERIDAN ST,PORT TANI WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION /
Underground PROPANE TANK* // Above Ground PROPANE TANK V HEAT STOVE HOT WATER TANK
WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE - N 6 2003
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):
3 / F///CH L. "/ Cog ►bC/t ^L1_EA/
ZIP T $ CGS
p
9 DIGIT PARCEL ID NUMBER ` %$ Y er O C / Co
Legal Description:
Subdivision Name Block Lot(s) / O
Section Township North, Range WM
APPLICANT jr- /... O.D /r/ PHONE V y 2 G 7 2 7
MAILING ADDRESS P O 8 O ,( / / Z 4 3
ZIP
PROPERTY OWNER ,.S.A- /`1 LS PHONE
MAILING ADDRESS
ZIP
CONTRACTOR 3 u a U,t d A N P 12 a /'A A►, PHONE
MAILING ADDRESS
[ ZIP
STATE LICENSE# 7U e U RPL PA 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 of entry to the applicant's property or structur shall be requested and shall occur during regular business hours.
APPLICANT'S SIGNATURE ,✓L 7 7 DATE cS / I `7 / 0
4.7,00 FOR OFFICE USE ONLY /+,
BASE FEE RECEIPT# CO7
CONSISTENCY REVIEW ,�/� CASH/CK# i 0
TOTAL 4-7 .00 DATE k / <(,)/ o3
*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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