HomeMy WebLinkAboutBLD2003-00116 •
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 #: BLD03-00116 Received Date 2/28/2003
SITE ADDRESS: 41-3 HIGHLAND GREENS Issue Date 2/28/2003
PORT LUDLOW, 98365
APPLICANT: KEITH R GAGE PHONE: (360)437-9581
AGNES A GAGE
41 HIGHLAND GRN UNIT 3
PORT LUDLOW WA 98365-8797 7
SUBDIVISION: HIGHLAND GREENS CONDOS Block: Lot:
PARCEL NUMBER: 959500036 Section: 21 Township: 28N Range: 01 E
CONTRACTOR: PETTIT OIL CO PHONE: (360)385-1420
PO BOX 1031
PORT TOWNSEND WA 98368
Contractor's License PETTIOCO88CC Expires 5/1/2004
OWNER, KEITH R GAGE PHONE: (360)437-9581
if different: AGNES A GAGE
41 HIGHLAND GRN UNIT 3
PORT LUDLOW WA 98365-8797
PROJECT DESCRIPTION: PROPANE TANK& HEAT 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 2/28/2004.
REQUIRED INSPECTIONS:
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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
BLD03-00116
41143UILDING PERMIT APPLICION Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00116 Received Date: 2/28/2003
SITE ADDRESS: 41-3 HIGHLAND GREENS
PORT LUDLOW, 98365
OWNER: KEITH R GAGE PHONE: (360)437-9581
AGNES A GAGE
41 HIGHLAND GRN UNIT 3
PORT LUDLOW WA 98365-8797
SUBDIVISION: HIGHLAND GREENS CONDOS Block: Lot: 7
PARCEL NUMBER: 959500036 Section: 21 Township: 28 N Range: 01 E
CONTRACTOR: PETTIT OIL CO PHONE: (360)385-1420
PO BOX 1031
PORT TOWNSEND WA 98368
Contractor's License PETTI00088CC Expires 5/1/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION PROPANE TANK & HEAT 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
Propane Tanks/Stoves $47.00 MAM 02/28/03 55158
Total: $47.00
JEFFERSON COUNTY COMMUNOEVELOPMENT,621 SHERIDAN ST,PORT TOWD WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO I HIS INSTALLATION
Underground PROPANE TANK* X 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#/Road Name):
IV/ J yX%iff Cry,6.45- /J,
/ 7 %6Cdh&) W Q ZIP 7 Q c36.?
9 DIGIT PARCEL ID NUMBER R S !Q cf'OO 6, 6
Legal Description:
Subdivision Name Block Lot(s)
Section To North,North, Range VVM
APPLICANT t° (4 1 a a n es R Cre. 4 e PHONE d O- T 7 — 9�"ery
MAILING ADDRESS 7/ /// A /area' Greens ##' 3
P"f kctia t�J W .. ZIP 9 6' 36S
o1
PROPERTY OWNER 0,.wL -E2o OLZ- •v e PHONE
MAILING ADDRESS
ZIP
CONTRACTOR Pe—f'-f t—F 0 r I tY\ f)a r►y PHONE .36 D - - /#4 a
MAILING ADDRESS o73 Se7 ,, A7041-cl
Pit 776-ton sen d A,Iq zIP 9156 j— 97 99
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 righ of try to Jefferson County and it's employees, representatives or agents for the purpose of application review and any
required later inspections. Access and f en y to pp pp nt's property or structure shall be requested and shall occur during regular business hours.
APPLICANT'S SIGNATURE i� 1_ 4 DATE 4:52-2/ 27/ c 3
lro FOR OFFICE USE ONLY
BASE FEE RECEIPT# SS S
CONSISTENCY REVIEW // CASH/CK#
TOTAL `-iq • r DATE /Z3/ r52-->
Underground Propane Tank applications require additional information o I{r'submi �"y V E R
Please contact our office at 360-379-4450 if the back of this applicati i lark. v u
H:\HOME\PLNCNTR\INFOBLDG\FORMS\INSTALL.DOC
FEB 28 1003 ti
DEPT. OFJCOMMUN1 l Y DEVELOPMENT,