HomeMy WebLinkAboutBLD2003-00046 1110 0
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 #: BLD03-00046 Received Date 1/24/2003
SITE ADDRESS: 397 BISHOP HILL RD Issue Date 1/27/2003
CHIMACUM, 98325
APPLICANT: KELLI R LARSON PHONE: (360)732-0351
TIMOTHY L LARSON
PO BOX 1046
PORT HADLOCK WA 98339-1046 T 7
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 901353005 Section: 35 Township: 29N Range: 01W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPI983O6 Expires 9/26/2004
OWNER, KELLI R LARSON PHONE: (360)732-0351
if different: TIMOTHY L LARSON
PO BOX 1046
PORT HADLOCK WA 98339-1046
PROJECT DESCRIPTION: PROPANE TANK 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 1/27/2004.
REQUIRED INSPECTIONS:
[ ( Vdev-4,
Tank/Line/Appliance: 712A►s.) AI.) K (5t.,� ef)K
[ ] FinalApproval: 4Y G b I„/�4
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 APPLICSON BLD03-00046
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00046 Received Date: 1/24/2003
SITE ADDRESS: 397 BISHOP HILL RD
CHIMACUM, 98325
OWNER: KELLI R LARSON PHONE: (360)732-0351
TIMOTHY L LARSON
PO BOX 1046
PORT HADLOCK WA 98339-1046
SUBDIVISION: Block: Lot: T 7
PARCEL NUMBER: 901353005 Section: 35 Township: 29 N Range: 01 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 DESCRIPTIOI PROPANE TANK 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 Bv: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 MAM 01/24/03 52964
Total: $47.00
+ f JEFFERSON COUNTY COmmuippEVELOPMENT,621 SHERIDAN ST,PORT TOVVNIND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* /Abcde Ground PROPANE TANK 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 4NO
SITE ADDRESS(911#/Road Name):
39-7 "Pk`kirp 1-11.I I erk_
o Y 1.'i ✓Y>1C_-iktly-I ZIP F 9 7c�5,5
9 DIGIT PARCEL ID NUMBER (1®i 53 005
Legal Description:
Subdivision Name 1`X Block Lot(s)
Section 35 Township '. 0t North, Range ti3 WM
APPLICANT Lt PHONE 7 3 ` v 35 i
MAILING ADDRESS °1 1 B 1 c 401 ��
!(i v&L u ���1�- ZIP 611 a1
PROPERTY OWNER LA 1---Ctr,se
,l PHONE
2 11
MAILING ADDRESS <�
— Bishop 1-b I I erk,
C 1, ry &C-1 .L',-' 1 - ZIP 1� �
CONTRACTOR i��?O,:�.� (Li('Th r\-- _ PHONE 3t-)5 L f
MAILING ADDRESS V(�,�C((eL1�.C�Lt, -
Co f- ��•� ct I -- ZIP 6193/,��q
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 Ito Jefferson C ty and it's employees, representatives or agents for the purpose of application review and any
required later inspections. Access and right of e y to the,applica ' property or str cture shall be requested and shall occur during regular business hours.
APPLICANT'S SIGNATURE DATE t / `j / :.,)
BASE FEE FOR OFFICE USE ONLY RECEIPT# ,L=(
CONSISTENCY REVIEW CASH/CK#
TOTAL DATE
*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. MN*
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