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HomeMy WebLinkAboutBLD2003-00053 0 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 #: BLD03-00053 Received Date 1/28/2003 SITE ADDRESS: 360 N BEACH DR Issue Date 1/29/2003 PORT LUDLOW, 98365 APPLICANT: ROBERT S PARDO TRUSTEE PHONE: (805)886-3522 ELIZABETH V PARDO TRUSTEE 760 N SAN MARCOS RD SANTA BARBARA CA 93111 7 SUBDIVISION: BRIDGEHAVEN DIV 4 Block: Lot: PARCEL NUMBER: 934800007 Section: 16 Township: 27N Range: 01 E CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTP198306 Expires 9/26/2004 OWNER, ROBERT S PARDO TRUSTEE PHONE: (805)886-3522 if different: ELIZABETH V PARDO TRUSTEE 760 N SAN MARCOS RD SANTA BARBARA CA 93111 PROJECT DESCRIPTION: PROPANE TANK, PIPING & INSERT 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 1/29/2004. REQUIRED INSPECTIONS: n [ ] Tank/Line/Appliance: a7-3-03 /14 nalApproval: d ar Ø I//,1 .41 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 APPLICA N BLD03-00053 Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD03-00053 Received Date: 1/28/2003 SITE ADDRESS: 360 N BEACH DR PORT LUDLOW, 98365 OWNER: ROBERT S PARDO TRUSTEE PHONE: (805)886-3522 ELIZABETH V PARDO TRUSTEE 760 N SAN MARCOS RD SANTA BARBARA CA 93111 SUBDIVISION: BRIDGEHAVEN DIV 4 Block: Lot: 7 PARCEL NUMBER: 934800007 Section: 16 Township: 27 N Range: 01 E CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTPI98306 Expires 9/26/2004 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr PROPANE TANK, PIPING & INSERT 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 01/28/03 54928 Total: $47.00 y JEFFERSON COUNTY COMMUNI•EVELOPMENT,621 SHERIDAN ST,PORT TOWN WA 98368 PH: (360)379-4450 INSTALLATION PERMIT APPLICATION WOODSTOVE V.Above Ground PROPANE TANK PELLET STOVE OTHER ?,le/1nS t .i Yl$e r fi 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): 360 N , gPeqcA Pr . ? 7 rt )—v©101 /0L✓ / I.✓� . ZIP 7'S3 9 DIGIT PARCEL ID NUMBER 7 3 y - S 00 ` 0 0 -2 Legal Description: Subdivision Name Block Lot(s) Section Township North, Range WM APPLICANT PHONE MAILING ADDRESS ZIP PROPERTY OWNER )20brc1 Pc? PHONE %Os- g456 - 3Sa2-2-- MAILING ADDRESS 760 N, S Q n /1Q reo5 Rd Ss'r17c3 ggaiArq Q/ t 4, ZIP 73 /) I CONTRACTOR /J"490tint-g o/9 Pro 149,1 e PHONE 360 - 3155- - 6SS3 MAILING ADDRESS e1-45} Ch/rY/ Q C Birk, 26, Po r / 1- Qd 1o6,, W 4' . ZIP 9 5 331 STATE LICENSE# ,(O a -- 0 7? - a-4.)- 9 EXP.DATE ' „A-6 -0 y FEDERAL I.D.# y1 - ;0S5655- 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 right of entry to the applicant's property or structure shall be requested and shall occur during regular business hours. APPLICANT SIGNATURE 7./i/e7 ...-AZ...--------- DATE I / ,f9-g// 0-3 FOR OFFICE USE ONLY BASE FEE RECEIPT# 511(1-2-g, CASH/CK# L'��jj TOTAL DATE Ll2-E/ C)y� H:HOME\PLNCNTR\INFOBLDG\FORMS\INSTALL.DOC11/05/01