HomeMy WebLinkAboutBLD2003-00078 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 #: BLD03-00078 Received Date 2/11/2003
SITE ADDRESS: 62 LAUREL ST Issue Date 2/11/2003
PORT HADLOCK, 98339
APPLICANT: JUNG K MOK TRUSTEE PHONE: (360)385-6625
MARY C MOK TRUSTEE
62 LAUREL ST
PORT HADLOCK WA 98339-9720
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 921063007 Section: 6 Township: 29N Range: 01 E
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPI983O6 Expires 9/26/2004
OWNER, JUNG K MOK TRUSTEE PHONE: (360)385-6625
if different: MARY C MOK TRUSTEE
62 LAUREL ST
PORT HADLOCK WA 98339-9720
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 2/11/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[ ] FinalApproval: FA -01(Y 1-30-1:9,4
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 APPLIC N B Review
8
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00078 Received Date: 2/11/2003
SITE ADDRESS: 62 LAUREL ST
PORT HADLOCK, 98339
OWNER: JUNG K MOK TRUSTEE PHONE: (360)385-6625
MARY C MOK TRUSTEE
62 LAUREL ST
PORT HADLOCK WA 98339-9720
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 921063007 Section: 6 Township: 29 N Range: 01 E
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPI983O6 Expires 9/26/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION 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 02/11/03 55009
Total: $47.00
JEFFERSON COUNTY COMMUN•EVELOPMENT,621 SHERIDAN ST,PORT TOWN',WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* VAbove 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 NO
SITE ADDRESS(911#/Road Name): 1 X
ZIP C C7
9 DIGIT PARCEL ID NUMBER 45\Z i u b 001
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT IA 1�L7N - , . c\70 PHONE :),0 5 � tiz
MAILING ADDRESS VL, -' -- Vr.L 4:1" VC' -r -3,- L `-t- -, VJQ
ZIP c.a�� ��
PROPERTY OWNER Mom'IC ' 1 '`' t L \ L eLc 5 ` PHONE &) 3 �b
MAILING ADDRESS 4 2.. � '6_ 1 Q0"'SZ 4S V ter , \?A
ZIP S- .1
(��
CONTRACTOR c►1 b Wq c-{ ) I\ PHONE
MAILING ADDRESS
ZIP
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 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 applica 's prop ty or structure shall be requested and shall occur during regular business hours.
APPLICANT'S SIGNATURE .\----<V*--,n DATE Z. / k ! / o
FOR OFFICE USE ONLY
BASE FEE RECEIPT# ��5.50o 1
CONSISTENCY REVIEW CASH/CK# r77t 5'1
TOTAL 1"Cq ' W DATE / 1 t / 03
*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. IIM*
H:\HOM E\PLNCNTR\INFOBLDG\FORMS\INSTALL.DOC