HomeMy WebLinkAboutBLD2003-00048 • •
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 #: BLD03-00048 Received Date 1/27/2003
SITE ADDRESS: 934 PIPER RD Issue Date 1/28/2003
QUILCENE, 98376
APPLICANT: GARY Y PHILLIPS PHONE:
MARILEE PHILLIPS
450 PENNY CREEK RD
QUILCENE WA 98376-8533 T 1
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 701174006 Section: 17 Township: 27N 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, GARY Y PHILLIPS PHONE:
if different: MARILEE PHILLIPS
450 PENNY CREEK RD
QUILCENE WA 98376-8533
PROJECT DESCRIPTION: LP FORCED AIR FURNACE
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:
[ ] Tank/Line/Appliance: LF fORcED Al2 rue,w4c&--
[ ] FinalApproval: OK cot- FNAL_ 0.5/0,/,
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
"�_ BLD03-00048
UILDING PERMIT APPLICaION Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00048 Received Date: 1/27/2003
SITE ADDRESS: 934 PIPER RD
QUILCENE, 98376
OWNER: GARY Y PHILLIPS PHONE:
MARILEE PHILLIPS
450 PENNY CREEK RD
QUILCENE WA 98376-8533
SUBDIVISION: Block: Lot: T 1
PARCEL NUMBER: 701174006 Section: 17 Township: 27 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 DESCRIPTIOli LP FORCED AIR FURNACE
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 01/27/03 52970
Total: $47.00
.01/24/2003 14: 28 3603 94'Ft JEFF CO DCD PAGE 02/03
JEFFeR$ON COUNTY COMMUNII'P'DEVELOPMENT,621 SHF E'JIDAN ST,PORT TOWNS.WA 98368 Pit; (360]379.445Q
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* Above Ground PROPANE TANK HEAT STOVE HOT WATER TANK
WOODSTOVE FIREPLACE INSERT Y PELLET
-S�jt®OV E, COOKING STOVE
_ ,OTHER(Please Specify) L-P �,1 ( i° v- ki
Is this appliance(htg stove, hot water tank,furnace,etc.)to be installed in a Manufactured/Mobile Home?
—. -- YES 940
SITE ADDRESS(911 #I Road Name):
? k &r- Rd
9,, ee _ r., �°
�'� I �f� �/ ZIP �l1�✓7 �Q
9 DIGIT PARCEL ID NUMBER +c i ! (2
Legal Description;
Subdivision Name Blocl; Lots}
Section �/� Township North, Range - WM
APPLICANT PE1ttk75it/ ( 17c1/� PHONE, 9-qS/ � 77S -
MAILING ADDRESS 1/4 (A) 7 1/��, MIA---
/ 2 c - 7` 7- r(,5 W� ZIP
PROPERTY OWNER itla V7 / /I I /Il =) PHONE
MAILING ADDRESS -7 6 O Peii rl l reek--- /-t C/f
c?/..1../�1�9't . ZIP g53 7 ��
CONTRACTOR /P� j 4i t/,2 J-- <Z 7/ _ PHONE H,c {}:5 Zi
MAILING ADDRESS
qA � n t ' '1 �/�,�� ZIP
STATE LICENSE# P /J I/ 1-1-I a(^�7��cJ _ EXP,DATE, /.9-/e?/
FEDERAL 1,0,# / /7- / 3 .J1 7 /
By signing the application form, the apOIl r tiowner attests that the information provided herein Is true and correct to the best of their knowledge. Any materiel
falsehood or any omission of a material fert made by the applicant'ru.wnar witr,tespert to this appiiaation packet may result In tills wmit beirvg null and void,
I further agree to save, indemnify and hold harmless Jefferson County against all liabilities,Judgments, court costs, reasonable attorney's tees end expenses which
may in any wa.'I SCCrue aJ%i!1St Jeffefson CouAt,[ea a result of or in,nt)neeougnge of the granting,of this perr'nit,
I further agree to provide excess and rig t of.entry t0 Jefferson Co y and It's employees, representatives or agents for the purpose of application review and any
required later inspections, Access a q t entry t t ilc '' orope or structure shall be requested end shall occur during regular buaineee hours.
APPLICANT'S SIGNATURE GL .44,—;FjL — < /' DATE 7 1.4'2. 4-2,
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*Underground Propane Tank applicattarls require.aefditlanai Information to be submitted. OVER
Please contact our office at 360-379-4450 if the book of this application Is blank. 111111111110
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DEPT. OF COMMUNITY DEVELOPMENT