HomeMy WebLinkAboutBLD2003-00117 • •
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 #: BLD03-00117 Received Date 2/28/2003
SITE ADDRESS: 77 W MOORE ST Issue Date 2/28/2003
PORT HADLOCK, 98339
APPLICANT: GALE P MIDDLETON PHONE:
BARBARA A MIDDLETON
PO BOX 686
PORT TOWNSEND WA 983680686
SUBDIVISION: IRONDALE Block: 55 Lot:
PARCEL NUMBER: 961805504 Section: 34 Township: 30N Range: 01W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTP198306 Expires 09/26/2004
OWNER, GALE P MIDDLETON PHONE:
if different: BARBARA A MIDDLETON
PO BOX 686
PORT TOWNSEND WA 983680686
PROJECT DESCRIPTION INSTALL PROPANE TANK,DEMAND HOTWATER HEATER,RANGE
ANU UKYtK
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 02/28/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: rJyl(/� PIT(l=i . - L' n/ Q<< _W/2749.3
[ ] FinalApproval:
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.rp
t 10/29/19
JEFFERSON COUNTY COMMY DEVELOPMENT,621 SHERIDAN ST,PORT TOV ND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN T. THIS INSTALLATION
/
Underground PROPANE TANK* Above Ground PROPANE TANK HEAT STOVE HOT WATER TANK
/ WOODSTOVE FIREPLACE INSERT PELLET STOVE V COOKING STOVE
4 OTHER(Please Specify) 1J9=(I .
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):
/ ZIP
9 DIGIT PARCEL ID NUMBER 9`( 'SOTS So*
Legal Description:
Subdivision Name Block Lot(s)
aSection/ _ I- Township North, Range WM
APPLICANT j t,.`! l C�^S(��rlu LT, �n / PHONE �-'b '- 7-6 S OZ S
MAILING ADDRESS PC 1TX v 6 �C/� /..wn S e/liz t 4.
// ZIP 9't3b
PROPERTY OWNER 4, P ./�i. (�-(-, PHONE 5.6a— 3 `b s' 5
�Z /
MAILING ADDRESS /3"3 ZZ'�a 37 /old l v✓'1 SQ,-ic/ LNIA
ZIP Z% ) z c
N(o(/In+nin j�opcinZ PHONE 36 ✓� J—(� 16 3
CONTRACTOR - �C •� 1
MAILING ADDRESS Z65 G/;.,--iac_•.rl'a'J pc( cc``
ZIP . Yff'f '
STATE LICENSE# -'-('(✓A/r i P_7 `b 3 0 o EXP.DATE //Z 6 /6' /-
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 a licant's property or structure shall be requested and shall occur during regular business hours.
i
APPLICANT'S SIGNATURE e IV DATE v / 2/6 / a3
,,(( `,3 FOR OFFICE USE ONLY
BASE FEE `f'�-(/v RECEIPT# S S0 C;v•Ct
CONSISTENCY REVIEW 7 CASH/CK# dL(--
TOTAL 41-C90 DATE Z""l 2- / b3
*Underground Propane Tank applications require additional information to be submitted.
Please contact our office at 360-379-4450 if the back of this application is blank. D l`9 Tt, 11 & l i •11
,,
g:\permitcenter\forms\bldg forms\install-revised 10-23-02.doc i
1 U f 8 28 L,.),
1
JEFFERSON COUNTY
DEPT, OF COMMUNITY DEVELOPMENT
• BUILDING PERMIT APPLIAT Review
ION 00117
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD03-00117 Received Date: 2/28/2003
SITE ADDRESS: 77 W MOORE ST
PORT HADLOCK, 98339
OWNER: GALE P MIDDLETON PHONE:
BARBARA A MIDDLETON
PO BOX 686
PORT TOWNSEND WA 983680686
SUBDIVISION: IRONDALE Block: 55 Lot:
PARCEL NUMBER: 961805504 Section: 34 Township: 30 N Range: 01 W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPI983O6 Expires 09/26/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIO INSTALL PROPANE TANK,DEMAND HOTWATER HEATER,RANGE
AND DRYER
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 1997 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: 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
F&W Landslide
Routing Date: Shoreline Aquifer
Forest: Commercial Rural
Proximity Plat Conditions
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 PRB 02/28/03 55069
Total: $47.00