HomeMy WebLinkAboutBLD2003-00057 •
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 #: BLD03-00057 Received Date 2/3/2003
SITE ADDRESS: 452 FOUR CORNERS RD Issue Date 2/4/2003
PORT TOWNSEND, 98368
APPLICANT: ELMER B SETON PHONE: (360)385-2895
452 FOUR CORNERS RD
PORT TOWNSEND WA 98368-9369
T 33
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 001334010 Section: 33 Township: 30N Range: 01W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2004
OWNER, ELMER B SETON PHONE: (360)385-2895
if different: 452 FOUR CORNERS RD
PORT TOWNSEND WA 98368-9369
PROJECT DESCRIPTION: PROPANE TANK, PIPE & 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 2/4/2004.
REQUIRED INSPECTIONS:
[`-] Tank/Line/Appliance: esi))<-- --LZ ; 03
[ ;]. FinalApproval: Z. --5-103
/L
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
0057
�UILDING PERMIT APPLIC•ON BL Review Type:
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00057 Received Date: 2/3/2003
SITE ADDRESS: 452 FOUR CORNERS RD
PORT TOWNSEND, 98368
OWNER: ELMER B SETON PHONE: (360)385-2895
452 FOUR CORNERS RD
PORT TOWNSEND WA 98368-9369
SUBDIVISION: Block: Lot: T 33
PARCEL NUMBER: 001334010 Section: 33 Township: 30 N Range: 01 W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOli PROPANE TANK, PIPE & STOVE
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
Total:
.411pr
JEFFERSON COUNTY COMMUF'JEVELOPMENT,621 SHERIDAN ST,PORT TOW.D WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* Above Ground PROPANE TANK lH�OVE 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 NO
SITE ADDRESS(911#/Road Name):
f, ' %v444 E.vo-0 ZIP f fj(o
9 DIGIT PARCEL ID NUMBER 00/ 3 3/ 6/ O
Legal Description:
Subdivision Name Block Lot(s)
Section Township North,North, Range WM
APPLICANT f //4-62-74
J-/ice- PHONE 3g.r"-'2gf-J
MAILING ADDRESS —
ZIP
PROPERTY OWNER PHONE o
MAILING ADDRESS
ZIP
CONTRACTOR vP� U/�15�0 A- ( PHONE
MAILING ADDRESS /(C�3',j.3 at-e�Q.,, /--+�
` / - (( ZIP
STATE LICENSE# cSun f -+*. 07 7 Or EXP.DATE "/b
FEDERAL I.D.# ) 1071 8S 7
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 t'the applicant's property or structure sha`l be requested and shall occur during regular business hours.
APPLICANT'S SIGNATURE (: //y iL1 _ c DATE / • / 3 6 / d 3
FO ICE USE ONLY I
L. Ii
BASE FEE FEB »- 3 2003RE4 4Pi'# ,Jt�,L� g Ti
CONSISTENCY REVIEW CASH/CKK# C-
. _DD 1"
TOTAL DEPT. OFJCOMMUNIfY DEVELOPh1 NT / /
*Underground Propane Tank applications require additional information to be submitted. Please contact our office at 360-379-4450 if the back of
this application is blank.
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