HomeMy WebLinkAboutBLD2003-00126 • S
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 #: BLD03-00126 Received Date 3/4/2003
SITE ADDRESS: 190 E HEMLOCK ST Issue Date 3/4/2003
PORT LUDLOW, 98365
APPLICANT: ARTHUR E SUTTON TRUSTEE PHONE:
DONNA M SUTTON TRUSTEE
140 FAST HEMLOCK ST
PORT LUDLOW WA 98365
SUBDIVISION: PARADISE BAY ESTATES Block: Lot:
PARCEL NUMBER: 983400412 Section: 23 Township: 28N Range: 01 E
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 09/06/2004
OWNER, ARTHUR E SUTTON TRUSTEE PHONE:
if different: DONNA M SUTTON TRUSTEE
140 FAST HEMLOCK ST
PORT LUDLOW WA 98365
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 03/04/2004.
REQUIRED INSPECTIONS:
[L] Tank/Line/Appliance: dk � l4/413
r] ' FinalApproval: dK r01- G/!, 3/'4/t13A -
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_Perm it_Propane.rpt 10/29/19
• BUILDING PERMIT APPLILION BLD03-00126
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00126 Received Date: 3/4/2003
SITE ADDRESS: 190 E HEMLOCK ST
PORT LUDLOW, 98365
OWNER: ARTHUR E SUTTON TRUSTEE PHONE:
DONNA M SUTTON TRUSTEE
140 FAST HEMLOCK ST
PORT LUDLOW WA 98365
SUBDIVISION: PARADISE BAY ESTATES Block: Lot:
PARCEL NUMBER: 983400412 Section: 23 Township: 28 N Range: 01 E
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 09/06/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIO PROPANE TANK INSTALLATION
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 1997 HEAT BASE: HEAT TYPE:
OCCUPANCY:
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
Seismic Streams
Prop: Prop: Flood Way Floodplain
Total: Total: 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 03/04/03 55073
Total: $47.00
JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNSEND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE X Above Ground PROPANE TANK PELLET STOVE OTHER
Is this appliance (htg stove, hot water tank,furnace, etc.)to be installed in a Manufactured/Mobile Home?
YES X NO
SITE ADDRESS(911#/Road Name):
C) L _IA C /v A ZIP 19g.91
9 DIGIT PARCEL ID NUMBER (S 1 C>Q — ' ;..
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT /4.(z t'i" t fit' '7-L(\,) //7 PHONE / G
MAILING ADDRESS 1 5 A S-17 j4.E.�1r' LAC c r';/'lL c k.4 l rr I S
rr L_ T1✓.� L VJ 1 4 ZIP 1 g"
PROPERTY OWNER IC .0.,r r` L,k*--.77T-0/\), PHONE " " i
40
MAILING ADDRESS 1 - " LOC,K. ��I-7 ( 1
1 Po R LUbLO C- CJ /
i\Wil ZIP d -3
CONTRACTOR " 1 v EX' PHONE — 5
MAILING ADDRESS 70 3 > 27d..-443
�v
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.
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APPLICANT SIGNATURE f ,/.�_!J-�_r DATE / T / 6
06
BASE FEE FOR OFFICE USE ONLY ,\ l�/
47 / RECEIPT# V3
/- CASH/CK# CAA
TOTAL� � DATE 3 / q-/ 03
H:\HOME\PLNCNTR\INFOBLDG\FORMS\INSTALL.DOC 11/05/01