HomeMy WebLinkAboutBLD2003-00105 • Ill
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 #: BLD03-00105 Received Date 2/24/2003
SITE ADDRESS: 110 PALAMINO LN Issue Date 2/24/2003
BRINNON, 98320
APPLICANT: STAN WA ER PHONE: (360)796-3078
PO BOX 229
BRINNON WA 98320
68,69
SUBDIVISION: LAZY C RANCH DIV 1 Block: Lot:
PARCEL NUMBER: 966900062 Section: 34 Township: 26N Range: 02W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2004
OWNER, ROBERT T CLARK PHONE:
if different: 104 10TH ST NE APT 131
AUBURN WA 98002-4055
PROJECT DESCRIPTION: PROPANE TANK& PIPING
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 2/24/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: :_�• 4-//4;. e 7-,,pu c -,7-0>
[ ] FinalApproval: .2 7'c3
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
i:\F_BLD_Permit_Propanespt rpt 10/29/19
UILDING PERMIT APPLIC ON BLDOe 001105
w Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLDO3-00105 Received Date: 2/24/2003
SITE ADDRESS: 110 PALAMINO LN
BRINNON, 98320
OWNER: ROBERT T CLARK PHONE:
104 10TH ST NE APT 131
AUBURN WA 98002-4055
SUBDIVISION: LAZY C RANCH DIV 1 Block: Lot: 68,69
PARCEL NUMBER: 966900062 Section: 34 Township: 26 N Range: 02 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 DESCRIPTION PROPANE TANK & PIPING
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 02/24/03 55042
Total: $47.00
JEFFERSON COUNTY COMMUNIODEVELOPMENT,621 SHERIDAN ST,PORT TOWD WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THISr II—NSTALLATION
644
Underground PROPANE TANK* ?C Above GroundPROPANE TANK HEAT STOVE HOT WATER TANK
WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE
OTHER(Please Specify) 6r6-dio' .0_ I SLR-69�r�c...-cty
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):
I 0 P -t- . L V\ , +
8r11�11'1.b Y "l� W A ZIP o 3 L 0
.# 9 DIGIT PARCEL ID NUMBER Qtk_`p e40002. c 1""awl. ).
rr
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT S+ /J `�I G PHONE 7/Cs la 7 O
MAILING ADDRESS .6 $ay 2-2_ j
.r4hh (IL(f ZIP 4 u 3 L0
PROPERTY OWNER 9 e-4114- PHONE
MAILING ADDRESS
ZIP
CONTRACTOR j ALt.JYJ°.+�— PHONE
MAILING ADDRESS /o'S3 L ✓ c c,
�G _ t�� ..�-���1 ! (.� ZIP l 3f /
STATE LICENSE# Si(n S t+9- t 77 Qn EXP.DATE ///1
FEDERAL I.D.# !i - L 01 4 PS7
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 entry to the applicant's property or structure shall be requested and shall occur during regular business hours.
APPLICANT'S SIGNATURE .--, 1. VC)1&\-4C DATE Z. /Zcf /O3
BASE FEE FOR OFFICE USE ONLY RECEIPT# l.J
---7_ 55 "f�
CONSISTENCY REVIEW �.�{�V CASH/CK# I T°1
TOTAL Li:- - V DATE 2 2!±' 03
*Underground Propane Tank applications require additional pnp n formatirrrbrrr; . E R
Please contact our office at 360-379-4450 if the back of this application. n i`ll''I'��
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