HomeMy WebLinkAboutBLD2003-00036 -0 0. t.
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 #: BLD03-00036 Received Date 1/21/2003
SITE ADDRESS: 292 POCKET LN Issue Date 1/22/2003
PORT TOWNSEND, 98368
APPLICANT: LYNN N TAYLOR PHONE: (360)385-3666
JENIFER TAYLOR
292 POCKET LANE
PORT TOWNSEND WA 98368 T 4
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 002242008 Section: 24 Township: 30N Range: 02W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPI983O6 Expires 9/26/2004
OWNER, LYNN N TAYLOR PHONE: (360)385-3666
if different: JENIFER TAYLOR
292 POCKET LANE
PORT TOWNSEND WA 98368
PROJECT DESCRIPTION: PROPANE TANK& HEAT 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 1/22/2004.
REQUIRED INSPECTIONS:
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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_B LD_Perm it_Propane.rpt 10/29/19
•UILDING PERMIT APPLICAAN $LD03-00036
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00036 Received Date: 1/21/2003
SITE ADDRESS: 292 POCKET LN
PORT TOWNSEND, 98368
OWNER: LYNN N TAYLOR PHONE: (360)385-3666
JENIFER TAYLOR
292 POCKET LANE
PORT TOWNSEND WA 98368
SUBDIVISION: Block: Lot: T 4
PARCEL NUMBER: 002242008 Section: 24 Township: 30 N Range: 02 W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTP198306 Expires 9/26/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr PROPANE TANK & HEAT 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
Prop: Prop: Seismic Streams
Total: Total: Flood Way Floodplain
Routing Date: F&W Landslide
Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid Bv: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 MAM 01/21/03 52915
Total: $47.00
JEFFERSON COUNTY COMMUI' EVELOPMENT,621 SHERIDAN ST,PORT TOWD WA 98368 PH: (360)379-4450
INSLLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS TAINSTALLATION
Underground PROPANE TANK* )<'
Above Ground PROPANE TANK HEAT STOVE HOT WATER TANK
WOODSTOVE FIREPLACE INSERT PELLET STOVE IC COOKING STOVE
OTHER(Please Specify)
Is this appliance(htg stove, hot water tank,furnace,etc.)to be installed in a Manufactured/Mobile Home?
YES cler NO
SITE ADDRESS(911#/Road Name):
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9 DIGIT PARCEL ID NUMBER 00 2 4 2 00 d
Legal Description:
Subdivision Name Block Lot(s)
jj Section / Township North, Range WM
APPLICANT ICL/ PHONE C3 (0) 3 Rs 36
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MAILING ADDRESS q ` -- (-'came-kta_+1 t e•
Pc I P- •S 1, IA/ ZIP le36
PROPERTY OWNER PHONE
MAILING ADDRESS oviret.IL
�.Jv
ZIP
CONTRACTOR / fe--6 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 entr to Jefferson County and it's employees, representatives or agents for the purpose of application review and any
required later inspections. Access and right of tr to the a lican ' property or structure shall be requested and shall occur during regular business hours.
APPLICANT'S SIGNATURE ti' DATE / / :Z I / 03
(
FOR OFFICE USE ONLY
BASE FEE Y 7.6° RECEIPT#
CONSISTENCY REVIEW CASH/CK# J
TOTAL f 7- 0 DATE / /c / �.3
*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.
H:\HOME\PLNCNTR\INFOBLDG\FORMS\INSTALL.DOC
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JEFFERSON COUNTY DCD