HomeMy WebLinkAboutBLD2003-00133 •
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 #: BLD03-00133 Received Date 3/6/2003
SITE ADDRESS: 630 RHODODENDRON LN Issue Date 3/6/2003
BRINNON, 98320
APPLICANT: NORMA A ROBINSON PHONE:
PO BOX 192
WASHOUGAL WA 986710192
37
SUBDIVISION: PLEASANT TIDES Block: Lot:
PARCEL NUMBER: 988500036 Section: 14 Township: 25N Range: 02W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTP198306 Expires 09/26/2004
OWNER, NORMA A ROBINSON PHONE:
if different: PO BOX 192
WASHOUGAL WA 986710192
PROJECT DESCRIPTION UNDERGROUND PROPANE TANK AND FURNACE
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:
[ ] Tank/Line ppliance:
[ ] FinalApproval: -tar-
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:\F_BLD_Permit_Propane.rpt 10/29/19
illo BUILDING PERMIT APPLIc TION BLD03-00133
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-001 33 Received Date: 3/6/2003
SITE ADDRESS: 630 RHODODENDRON LN
BRINNON, 98320
OWNER: NORMA A ROBINSON PHONE:
PO BOX 192
WASH GAL WA 986710192
SUBDIVISION: PLEASANT TIDES Block: Lot: 37
PARCEL NUMBER: 988500036 Section: 14 Township: 25 N Range: 02 W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTP198306 Expires 09/26/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIO UNDERGROUND PROPANE TANK AND FURNACE
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 55057
Total: $47.00
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JEFFERSON COUNTY,COMM.DEVELOPMENT,621 SHERIDAN ST,PORT TO•ND WA 98368 PH: (360)379-4450
K
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
XUnderground PROPANE TANK* Above Ground PROPANE TANK u HEAT STOVE HOT WATER TANK
WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE
L.1i — 1
OTHER(Please Specify)
Is this appliance (htg stove, hot water tank,furnace, etc.)to be installed in a Manufactured/Mobile Home? •
'YES ;
SITE ADDRESS(911#/Road Name): f J
Irop
13 'v^ i h f1 o h ili A. , ZIP c,`1'R-J b
9 DIGIT PARCEL ID NUMBER Ci k5 (Si- 0 O 6'R a-- 9ts-, — s'O cj 6 -i , ,,
Legal Description: j
Subdivision Name r 'e_a Sq 11 1 I I d e,S Block Lot(s)
Section Township North, Range WM
APPLICANT AL r w\cL , p I In S o V? PHONE .7q - 3 :Z cikO
MAILING ADDRESS I l bu o v �el I
Rr ; 1, r) p, f-1 wA ZIP Q qS3 `Q 0
PROPERTY OWNER )? ID S'G t/ l `�� O Y' V°Y7 cA o i )�., CIl� ��OI� PHONE 7 �/� - � c7
MAILING ADDRESS 11 b ID G q 'vU O o d L el , ��
3hi1l VI obi VI/ 1,(/'
ZIP CiS3 :,2 O
CONTRACTOR E3' F7' MOO(0-40{I , PHONE
MAILING ADDRESS ( S ct vv) x'
ZIP
STATE LICENSE# ._ EXP.DATE
,l 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 ri ht of entry to the applicant's property or ss ructure shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE ' ' 1 ,n ^"-- , 1 t-e-�GW 'j DATE / /
4_7 cO FOR OFFICE USE ONLY
BASE FEE RECEIPT# L cO,S7
CONSISTENCY REVIEW 23 12" CASH/CK# C-04
TOTAL 19 DATE ?j / ‘:;) / 03"
*Underground Propane Tank applications require additional information to be submitted. OVER
Please contact our office at 360-379-4450 if the back of this application is blank.
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