HomeMy WebLinkAboutBLD2003-00109 1110 e - _
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 #: BLD03-00109 Received Date 2/26/2003
SITE ADDRESS: 101 D ST Issue Date 2/27/2003
PORT HADLOCK, 98339
APPLICANT: KEVIN T TAYLOR PHONE: (360)379-1313
ANGELA L SCHRIVER
PO BOX 1444
PORT HADLOCK WA 98339-1444 13-14
SUBDIVISION: SOUTH PORT TOWNSEND Block: 6 Lot:
PARCEL NUMBER: 996400607 Section: 2 Township: 29N Range: 01W
CONTRACTOR: FERRELLGAS PHONE: (360)582-0231
646 SO 3RD AVE
SEQUIM WA 98382
Contractor's License FERRELP055LH Expires 8/1/2004
OWNER, KEVIN T TAYLOR PHONE: (360)379-1313
if different: ANGELA L SCHRIVER
PO BOX 1444
PORT HADLOCK WA 98339-1444
PROJECT DESCRIPTION: PROPANE TANK& HEAT STOVE 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 2/27/2004.
REQUIRED INSPECTIONS:
[ ] Ta nk/ ine/Applianc))e.._S-5 a_
[ .I FinalApprova . r., . 5 (o
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_Propane.rpt 10/29/19
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UILDING PERMIT APPLIC ON B RDOe 00109
eviw Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00109 Received Date: 2/26/2003
SITE ADDRESS: 101 DST
PORT HADLOCK, 98339
OWNER: KEVIN T TAYLOR PHONE: (360)379-1313
ANGELA L SCHRIVER
PO BOX 1444
PORT HADLOCK WA 98339-1444
SUBDIVISION: SOUTH PORT TOWNSEND Block: 6 Lot: 13-14
PARCEL NUMBER: 996400607 Section: 2 Township: 29 N Range: 01 W
CONTRACTOR: FERRELLGAS PHONE: (360)582-0231
646 SO 3RD AVE
SEQUIM WA 98382
Contractor's License FERRELP055LH Expires 8/1/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION PROPANE TANK & HEAT STOVE 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:
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 02/26/03 55105
Total: $47.00
JEFFERSON COUNTY COMMUNIIEVELOPMENT,621 SHERIDAN ST,PORT TOWNOD 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 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#Ro Name): , lite `4., /
/7`✓�LO� o4 GL61r4�j j?rfri
ZIP 9/B9
9 DIGIT PARCEL ID NUMBER -R(0 400 O-q`
Legal Description:
Subdivision Name Block Lot(s)
LSection Township North, Range WM
APPLICANT /41;41 /lei /a/A)/ PHON `""'
MAILING ADDRESS /—i a 014,
ZIP gi
PROPERTY OWNER PHONE
MAILING ADDRESS
� ZIP
CONTRACTOR �rr�i �J+ 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 applicant's property or structure shall be requested and shall occur during regular business hours.
APPLICANT'S SIGNATURE DATE
FOR OFFICE USE ONLY
BASE FEE RECEIPT# 55 1015
CONSISTENCY REVIEW �Jt.4 2- /!�t
CASH/CK# 2(o 2-
TOTAL DATE p/0�72
rti*Underground Propane Tank applications require additional informitti igst4itfe'21. 'V E R
Please contact our office at 360-379-4450 if the back of this applicati
H:\HOME\PLNCNTR\INFOBLDG\FORMS\INSTALL.DOC `1
uF FEB 26 1001
DEPT. OFJCOMM!UNI i Y DEVELOPMENT