HomeMy WebLinkAboutBLD2003-00047 • •
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 #: BLD03-00047 Received Date 1/27/2003
SITE ADDRESS: 1000 DABOB RD Issue Date 1/28/2003
QUILCENE, 98376
APPLICANT: TERESA A PATMORE PHONE: (360)732-7314
LAWRENCE J LEWIS
1000 DABOB RD
QUILCENE WA 98376-9729
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 801212002 Section: 21 Township: 28N Range: 01W
CONTRACTOR: PENINSULA HEAT INC PHONE: 457-2775
502 W 8TH ST
PORT ANGELES WA 98362
Contractor's License PENNINI*0440W Expires 3/2/2004
OWNER, TERESA A PATMORE PHONE: (360)732-7314
if different: LAWRENCE J LEWIS
1000 DABOB RD
QUILCENE WA 98376-9729
PROJECT DESCRIPTION: HEAT PUMP 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 1/28/2004.
REQUIRED INSPECTIONS:
-[ 4 Tank/Line/Appliance: 41EAT �u MS' 1 stict.i la` vws COI.) 4-�
I/
210 /
[ ] FinalApproval: or c ci vt.2., Q,FPtz..atiJq,L 1/2.0/0
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
BLD03-00047
SUILDING PERMIT APPLICON Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00047 Received Date: 1/27/2003
SITE ADDRESS: 1000 DABOB RD
QUILCENE, 98376
OWNER: TERESA A PATMORE PHONE: (360)732-7314
LAWRENCE J LEWIS
1000 DABOB RD
QUILCENE WA 98376-9729
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 801212002 Section: 21 Township: 28 N Range: 01 W
CONTRACTOR: PENINSULA HEAT INC PHONE: 457-2775
502 W 8TH ST
PORT ANGELES WA 98362
Contractor's License PENNINI*0440W Expires 3/2/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP HEAT PUMP 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:
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 By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 MAM 01/27/03 52971
Total: $47.00
01/24/200.3 14: 28 360394451 .JEFF CO DOD PAGE 02/03
.. .JEFFERSOtiCOUNTY COMMUNI•VELQPMENT.621 SHERIDald ST.PORT TOWNS.WA 98368 PH; (35O. 379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* Atxwe Ground PROPANE TANK HAT STOLE HOT WATER TAW
WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE
_,.],,,OTHER(Please Specify) a f
Is this appliance (htg stove,hot water tank,furnace,etc.)to be installed in a Manufactured/Mobile Home?
YES 440
SITE ADDRESS(911#/Road Name):
'O60 pabO b Roth
0 i.LA 1.0 1e, /�( )1�- zip j -7(
9 DIGIT PARCEL ID NUMBER �D/ [ . I 00
Legal Description:
Subdivision;game Block Lot(s1
Section Township ._ _ North, Range WM
APPLICANT Pf 0t I A5tit,�,(4 ` Pa+I c C PHONE _'1$7'-�-]�S'
MAILING ADDRESS 550 —'7
f a_!t !`f Y 1l I �Ci ZIP !a?J ,'a'�
PROPERTY OWNER L a r rj Le 1 s PHONE '/'fig--1 31
MAILING ADDRESS 100(Y . D/1,b6 h R 4 _
qui,I 1 teAcw., 1,V,,g- ZIP Clr+
CONTRACTOR Oe n IV16 a* ,,TA h PHONE ' 4 t 4,�.4-‘ 14-P'1O Ll eico l-
MAILING ADDRESS 11.E n /7P LA CA e. T
� 1 ��r' /� l'"' l ZIP
STATE LICENSE# o I J i+I Oa6 V 0 EXP,DATE 3/t TO
FEDERAL 1.0.# l'I ' I-7 3 j a—7 i
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 materiel
falsehood or arty omission of a material fact r nacle by*e appiicomrrrnner withh respect to this application pec cat may retWt in this permit beirva null and void.
I further agree to save, indemnify and hold harmless Jefferson County against all liabilities,Judgmerrts, 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 Jeffers County and It's employees, representatives or agents for the purpose of application review and any
required later inspections. Accesss/ t of e ry t cant's roperty or strucb)re shall be requested and shell occur during regular business hoours.
1�
APPLUCANT'SSIGNATURE r` , 1 I -1' -✓(.71 DATE / 1,av, G`
iiS E.�Gsrzt i� ,,., ?' r yK: ' FWR i✓IPi1E USE oNLI : �y�..y�,� •,'.. y:# ''', ' .9
N�� `�4 n�f t"It1F'`i'�' ,l r .4 ' i� t p-'
r4y?I +^ 7 to $
°,�
+ �
iclSty 4'SP, uutt hi 3.. =d. r-' DATE I ` 1 a� v,
*Underground Propane Tank applications require additional information to be aubmittod. OVER
Please contact our office at 360.3T4r4450 if the back of this application is blank. 111111.1*
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