HomeMy WebLinkAboutBLD2003-00124 • •
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 #: BLD03-00124 Received Date 3/3/2003
SITE ADDRESS: 275182 HWY 101 Issue Date 3/4/2003
SEQUIM, 98382
APPLICANT: MYLES 0 DUSTIN PHONE:
PATRICIA B DUSTIN
PO BOX 249
SEQUIM WA 98382-0249 T 36
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 002334004 Section: 33 Township: 30N 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, MYLES 0 DUSTIN PHONE:
if different: PATRICIA B DUSTIN
PO BOX 249
SEQUIM WA 98382-0249
PROJECT DESCRIPTION: HEAT STOVE & GAS PIPE
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 3/4/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: EGG tc .Qi1 ' istn) -y . olf,-
P6 6-t 5-v 0000
[ ] FinalApproval: f6 I I.S
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
is\F_BLD_Permit_Propane.rpt 10/29/19
03UILDING PERMIT APPLICAON BLD03-00124
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00124 Received Date: 3/3/2003
SITE ADDRESS: 275182 HWY 101
SEQUIM, 98382
OWNER: MYLES 0 DUSTIN PHONE:
PATRICIA B DUSTIN
PO BOX 249
SEQUIM WA 98382-0249
SUBDIVISION: Block: Lot: T 36
PARCEL NUMBER: 002334004 Section: 33 Township: 30 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 DESCRIPTIOI HEAT STOVE & GAS PIPE
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 03/03/03 55163
Total: $47.00
-. . , JEFFERSON COUNTY COMMUNISpEVELOPMENT,621 SHERIDAN ST,PORT TOWN 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
pOTHER(Please Specify) triL41''if 'tom
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):
a1 Si 2 )-- 10
ZIP
9 DIGIT PARCEL ID NUMBER CO �-- 3 3 r 0 o y,
Legal Description:
Subdivision Name Block Lot(s)
Section i Township North, Range WM
APPLICANT b t 0 (A, , PHONE
MAILING ADDRESS )--t ' 0-141
5 L_ Q Lo ri- ZIP
PROPERTY OWNER PHONE
MAILING ADDRESS
ZIP Q
CONTRACTORS pei,Ar-ve....., PHONE C� 3. J 7�7
MAILING ADDRESS I a S 3 0--+ ,(� .
P 1 c (.J— ZIP °9 3
STATE LICENSE# S tti/C S 0 7 Q 0 EXP.DATE ) )/ Q t
FEDERAL I.D.# q ( — J 01 c 8 /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 J ferson County and it's employees, representatives or agents for the purpose of application review and any
required later inspections. Access and ri ht of entry to t applicant's property or structure shall be rern'ested and shall occur during regular businessl hours.
APPLICANT'S SIGNATURE --DATE 2 / ?/ V
FOR OFFICE USE ONLY
BASE FEE RECEIPT#
CONSISTENCY REVIEW CASH/CK#
TOTAL � � i TE _/ / _
*Underground Propane Tank applications require additio ti�oE s e O V E R 10.
Please contact our office at 360-379-4450 if the back of thi 4i i it blank.
g:\permdcenter\forms\bldg forms\install-revised 10-23-02.doc - 3
MAR
DEPT. OF COMMUNITY DEVELOPMENT
Undergroun•ropane Tank Applicatiorequirements `"
When applying for a permit to install an underground propane tank you must submit the following:
1. Site plan showing all of the buildings, all property lines, tank location, distances from the tank
to all property lines and buildings, septic system components including the reserve area.
2. Tank must be installed per NLPGA#401-87. Copies are available in our office for a fee of
$.90.
3. Plans are required. You must submit a section view and a plan view with all dimensions.
4. An additional fee of$23.50 for Consistency Review is required. The total amount due at time
of application is $70.50.