HomeMy WebLinkAboutBLD2003-00128 • 0
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 #: BLD03-00128 Received Date 3/4/2003
SITE ADDRESS: 263 BLUEJAY LN Issue Date 3/4/2003
PORT LUDLOW, 98365
APPLICANT: VINCE B RICHEY PHONE: (360)437-9739
M JANE RICHEY
263 BLUEJAY LN
PORT LUDLOW WA 98365-9570 2
SUBDIVISION: OLYMPIC SHORES DIV 1 Block: Lot:
PARCEL NUMBER: 983300002 Section: 9 Township: 27N 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, VINCE B RICHEY PHONE: (360)437-9739
if different: M JANE RICHEY
263 BLUEJAY LN
PORT LUDLOW WA 98365-9570
PROJECT DESCRIPTION: PROPANE TANK& PIPING
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:
[ ] an'.'� - 'ppliance: /2/< 2//Q Df
oi-i,
[ ] FinalApproval: 0 --(2), 0 0/4/,
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
11143UILDING PERMIT APPLICIION BLD03-00128
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00128 Received Date: 3/4/2003
SITE ADDRESS: 263 BLUEJAY LN
PORT LUDLOW, 98365
OWNER: VINCE B RICHEY PHONE: (360)437-9739
M JANE RICHEY
263 BLUEJAY LN
PORT LUDLOW WA 98365-9570
SUBDIVISION: OLYMPIC SHORES DIV 1 Block: Lot: 2
PARCEL NUMBER: 983300002 Section: 9 Township: 27 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 & PIPING
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:
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
Routing Date: F&W Landslide
Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 MAM 03/04/03 55172
Total: $47.00
JEFFERSON COUNTY COMMUN•EVELOPMENT,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 CnOKING STOVE
yOTHER(Please Specify) pi 2 U4 t- --. ' A// tine] i-r-t--' ( i —;.
Is this appliance(htgstove, hot water tank,furnace, J
pp etc.)to be installed in a Manufactured/Mobile Home?
YES NO
SITE ADDRESS(911#/Road Name):
6 3 a,_ L ar-,/
Y v" , c.J a _ ZIP / y_36 I
q9 DIGIT PARCEL ID NUMBER 8 3 — 350 00.2
Legal Description:
Subdivision Name Block Lot(s)
Section i 9Q_Townsh /�f North, Range WM
APPLICANT V gip-- &{.Yi PHONE / 3 7, 7J7
MAILING ADDRESS
ZIP
PROPERTY OWNER «(J i-e- PHONE
MAILING ADDRESS
ZIP
CONTRACTOR 11. SUNSHINE PROPANE PHONE
I Quality Energy Services Since 1980
MAILING ADDRESS F 10853 Rhody Dr. Hadlock,WA 98339
(360)385-5797 or 683-4010
IF/ IS
l ZIP
�
www.sunshineepropane.com
STATE LICENSE# G7/7 s P
07 7 Q EXP.DATE �// O
FEDERAL I.D.# 9/ _ /®7, 7J 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 unty and it's employees, representatives or agents for the purpose of application review and any
required later inspections. Access and right of try to the appli is property or structure span be requested and shall occ r during regular business hours.
APPLICANT'S SIGNATURE �� /'~_ �' ccc E 3 / ,L /O3
FOR OFFICE USE
BASE FEE RECEIPT#
CONSISTENCY REVIEW CASH/CK#
TOTAL DATE / /
*Underground Propane Tank applications require additional information to be submitted. 0 V E R
Please contact our office at 360-379-4450 if the back of this application is blank.
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