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HomeMy WebLinkAboutBLD2003-00132 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 #: BLD03-001 32 Received Date 3/6/2003 SITE ADDRESS: 31 CASCADE LN Issue Date 3/6/2003 PORT LUDLOW, 98365 APPLICANT: BARBARA D LAVECK PHONE: 31 CASCADE LN PORT LUDLOW WA 983659535 21 SUBDIVISION: PORT LUDLOW NO. 1 Block: Lot: PARCEL NUMBER: 990400421 Section: 9 Township: 28N Range: 01 E CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTP198306 Expires 09/26/2004 OWNER, BARBARA D LAVECK PHONE: if different: 31 CASCADE LN PORT LUDLOW WA 983659535 PROJECT DESCRIPTION PROPANE TANK AND FIREPLACE INSERT 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 03/06/2004. REQUIRED INSPECTIONS: [ ] an .4Applian� OK 3 03 [ ] mal proval: �S.1.-5-A 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:1F_B LD_Perm it_Propane.rpt 10/29/19 • BUILDING PERMIT APPLICOTION BLD03-00132 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD03-00132 Received Date: 3/6/2003 SITE ADDRESS: 31 CASCADE LN PORT LUDLOW, 98365 OWNER: BARBARA D LAVECK PHONE: 31 CASCADE LN PORT LUDLOW WA 983659535 SUBDIVISION: PORT LUDLOW NO. 1 Block: Lot: 21 PARCEL NUMBER: 990400421 Section: 9 Township: 28 N Range: 01 E 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 PROPANE TANK AND FIREPLACE INSERT 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 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 03/06/03 55075 Total: $47.00 JEFFERSON COUNTY COMMS DEVELOPMENT,621 SHERIDAN ST,PORT TO•ND 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 "X, 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): 3/ G4..sc F' ZA,c RL-7 Li)L,U1,-. 1,"V//'". ZIP (f36-'` 9 DIGIT PARCEL ID NUMBER 9 tto t'CU Lfzi Legal Description: Subdivision Name Block Lot(s) Section Township North, Range WM APPLICANT D 1►O L /9'I/' C K PHONE '3 6°— Y-3 7` /,.2._5-/ MAILING ADDRESS 3/�j C�5(7✓a"DA Cam,rl J �� 1L--o vi !� S - ( . 4 ZIP / 3 e ��jV' PROPERTY OWNER ,i�r)yt.Q A-MA L ,,zc IL PHONE Y37 -lam MAILING ADDRESS ) (ii'c c.?",-,j.4_ f1 4-� A—7 Z✓I) \-,, ,ti l'\,74 ZIP f i'.3C,r- CONTRACTOR I fl a n t -7 ih, PfP-o .4 rti Fr PHONE MAILING ADDRESS U ZIP 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 entry to Jefferson Countysss and it's employees, representatives or agents for the purpose of application review and any required later inspections. Access and ri entr to the ap ant' property or structure shall be requested and shall occur during regular business hours. APPLICANTS SIGNATURE e /(// DATE -j / / C)3 47� FOR OFFICE USE ONLY BASE FEE — RECEIPT# SS01 S CONSISTENCY REVIEW CASH/CK# '1"f TOTAL `-t-7©� DATE 47 / 03 *Underground Propane Tank applications require additional information to be submitted. 0 V E R 0. II► 1/0- Please contact our office at 360-379-4450 if the back of this application is blank. g:lpermitcenterforms\bldg formstnstall-revised 10-23-02.doc