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Home My WebLink AboutBLD2003-00125 • 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 #: BLD03-00125 Received Date 3/3/2003 SITE ADDRESS: 536 SCHWARTZ RD Issue Date 3/4/2003 NORDLAND, 98358 APPLICANT: WILBUR L JURDEN JR PHONE: (360)385-9704 JUDITH D JURDEN 536 SCHWARTZ RD NORDLAND WA 98358 2 SUBDIVISION: Block: Lot: PARCEL NUMBER: 021282010 Section: 28 Township: 30N 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, WILBUR L JURDEN JR PHONE: (360)385-9704 if different: JUDITH D JURDEN 536 SCHWARTZ RD NORDLAND WA 98358 PROJECT DESCRIPTION: PROPANE TANK 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 3/4/2004. REQUIRED INSPECTIONS: [ ] 'ine/Appliance: .3/7/ [ ] (Fin pproval: Zak 5/17/03c79// 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 •UILDING PERMIT APPLIC BLD03-00125 �N Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD03-00125 Received Date: 3/3/2003 SITE ADDRESS: 536 SCHWARTZ RD NORDLAND, 98358 OWNER: WILBUR L JURDEN JR PHONE: (360)385-9704 JUDITH D JURDEN 536 SCHWARTZ RD NORDLAND WA 98358 SUBDIVISION: Block: Lot: 2 PARCEL NUMBER: 021282010 Section: 28 Township: 30 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 DESCRIPTION PROPANE TANK 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: 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 55164 Total: $47.00 JEFFERSON COUNTY COMMUNSEVELOPMENT,621 SHERIDAN ST,PORT TOWN.WA 98368 PH: (360)379-4450 INSTALLATION PERMIT APPLICATION MARK ALL ITEMS BELOW THAT PERTAIN�TOOTTHIS INSTALLATION Underground PROPANE TANK* b 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): J % 0)-- 44.0(---)-- c G' ZIP ( �JLI 9 DIGIT PARCEL ID NUMBER `F/ / rf a/ J Legal Description: Subdivision Name Block Lot(s) Section Township North, Range WM 7/ c1 �J yC APPLICANT 3/ _ G-L 7 GVf j PHONE 3 j7J / / 0 MAILING ADDRESS - 3 ,/'G,S Li 7, / ' r7�C/� C. G, -G(�j �J /�. ' ZIP ` s ' I C� PROPERTY OWNER v� _- PHONE • MAILING ADDRESS ZIP CONTRACTOR 4.,,,__64 r�- tr' / � PHONE MAILING ADDRESS /0 ?��3 4 --�`,-0 /0/- - -Liu-ex' G- ZIPLy �J STATE LICENSE# C J ke j? f - f" 7 7 CV / EXP.DATE /// 7 FEDERAL I.D.# 9/ _ /0'7/ f 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 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 ap truant's property or structure shall be requested and shall occur during regular business hours. APPLICANTS SIGNATURE ��/ lam) �' DATE a / ' 3/___Q FOR OFFICE USE ONLY ! (0 Ll BASE FEE RECEIPT# CONSISTENCY REVIEW CASH/CK# 67‘m , c TOTAL1 3 � *Underground Propane Tank applications require additional informatipt'r'tq bu rttt d E R / Please contact our office at 360-379-4450 if the back of this applicati ,s is to1-fi . g:\permitcenter\forms\bldg forms\install-revised 10-23-02.doc ARMS w. 3 DEPT.OF COMML;NIIY DEVELOPMENT