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HomeMy WebLinkAboutBLD2003-00106 • 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 #: BLD03-00106 Received Date 2/24/2003 SITE ADDRESS: 103 HERITAGE LN Issue Date 2/25/2003 PORT LUDLOW, 98365 APPLICANT: THOMAS L CARTER PHONE: (360)437-0980 MARGARET R CARTER 103 HERITAGE LN PORT LUDLOW WA 98365-9232 26 SUBDIVISION: TIMBERTON VILLAGE PHASE I Block: ? Lot: PARCEL NUMBER: 998500026 Section: 17 Township: 28N Range: 01 E CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2004 OWNER, THOMAS L CARTER PHONE: (360)437-0980 if different: MARGARET R CARTER 103 HERITAGE LN PORT LUDLOW WA 98365-9232 PROJECT DESCRIPTION: PROPANE TANK, PIPING & FIREPLACE 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 2/25/2004. REQUIRED INSPECTIONS: 64 Tank/Line/Appliance:--7-40 K/L1kSE/ /7PPL1E- dK 07/6/7 AFinalApproval: C/ C61— 0 J' 7/d3 ile 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 10/29/19 SUILDINGBLD03-00106 PERMIT APPLICON Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD03-00106 Received Date: 2/24/2003 SITE ADDRESS: 103 HERITAGE LN PORT LUDLOW, 98365 OWNER: THOMAS L CARTER PHONE: (360)437-0980 MARGARET R CARTER 103 HERITAGE LN PORT LUDLOW WA 98365-9232 SUBDIVISION: TIMBERTON VILLAGE PHASE I Block: ? Lot: 26 PARCEL NUMBER: 998500026 Section: 17 Township: 28 N Range: 01 E 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 DESCRIPTIOP PROPANE TANK, PIPING & FIREPLACE 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: 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 55046 Total: $47.00 - _ ^ JEFFERSON COUNTY COMMUNIEVELOPMENT,621 SHERIDAN ST,PORT TOWp 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 HEAT STOVE HOT WATER TANK WOODSTOVE L FIREPLACE INSERT PELLET STOVE COOKING STOVE OTHER(Please Specify) -1 hat- -C-- 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): /(3 i Z• 04, � 2 s �', ZIP (f, 6, 1-- 9 DIGIT PARCEL ID NUMBER q( d - 0-0 0 4 Legal Description: Subdivision Name Block Lot(s) Section Township North, Range WM jy APPLICANT d9ti (j + .[ � Yc C C -c PHONE "/ 3 7 © F'`}` MAILING ADDRESS Z n ZIP PROPERTY OWNER PHONE MAILING ADDRESS 0 CONTRACTOR �� SUNSHINE PROPANE ZONE �� Quality Energy Services Since 1980 10853 Rhody Dr. Hadlock,WA 98339 MAILING ADDRESS �/ '� (360)385-5797 or 683-4010 www.sunshinepropane.com STATE LICENSE# c�_� /< >(-64"/r) A, ;0' C / Q.( EXP. DATE ///a ty / FEDERAL I.D.# C r 7 ei 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 Jeffers ounty 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 app nt'S ropertyQr structur hall be requested and shall occur during regular business hours. i APPLICANT'S SIGNATURE A--- DATE _ /(:)/ / 6 i FOR OFFICE E ONLY BASE FEE RECEIPT# CONSISTENCY REVIEW CASH/CK# TOTAL _ Da=F -- / / *Underground Propane Tank applications require additional information tdr'-�brte ' D U Va Please contact our office at 360-379-4450 if the back of this application is b k - ----")I Ili ii H:WOME\PLNCNTR\INFOBLDG\FORMS\INSTALL.DOC i I inr-- iI FEB 2 4 2003 L J if DEPT. O ?t. 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