HomeMy WebLinkAboutBLD2003-00130 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#: BLD03-00130 Received Date 3/5/2003
SITE ADDRESS: 152 W ISLAND VIEW Issue Date 3/5/2003
PORT TOWNSEND, 98368
APPLICANT: DAVID D QUY PHONE:
DIANA LUDOVISSIE
PO BOX 114
PORT HADLOCK WA 983390114 1-4
SUBDIVISION: IRONDALE Block: 116 Lot:
PARCEL NUMBER: 962111601 Section: 34 Township: 30N Range: 01W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPI983O6 Expires 09/26/2004
OWNER, DAVID D QUY PHONE:
if different: DIANA LUDOVISSIE
PO BOX 114
PORT HADLOCK WA 983390114
PROJECT DESCRIPTION PROPANE TANK
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 03/05/2004
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: " 1/9NK a LdivE U K 4/V 03 yct
[ ] FinalApproval: n; -Cot- 0 iriVal k
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
�UILDIBLD03-00130NG PERMIT APPLICAtON Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00130 Received Date: 3/5/2003
SITE ADDRESS: 152 W ISLAND VIEW
PORT TOWNSEND, 98368
OWNER: DAVID D QUY PHONE:
DIANA LUDOVISSIE
PO BOX 114
PORT HADLOCK WA 983390114
SUBDIVISION: IRONDALE Block: 116 Lot: 1-4
PARCEL NUMBER: 962111601 Section: 34 Township: 30 N Range: 01 W
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
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 1997 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: 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
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 ZAN 03/05/03
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 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):1 f
r� ( ZIP �� _ /
9 DIGIT PARCEL ID NUMBER 9 ` f / 4/✓ /
Legal Description:
Subdivision Name Block Lot(s)
Section A Township North, Range �� WM
�APPLICANT D ( � PHONE 7 1 -� 7``f' /
MAILING ADDRESS PO 1 0I/v
pGI,e- TI i7� I- k / L4/ 9 ZIP ?3.2
PROPERTY OWNER ? /Xn'I PHONE
MAILING ADDRESS
ZIP
CONTRACTOR ? / ot)AfT?-/`V1 P ONE
MAILING ADDRESS
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 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.
APPLICANTS SIGNATURE DATE / / 1r}
41 fOJ FOR OFFICE USE ONLY RECEIPT# `v 3! 0�7
BASE FEE 1
CONSISTENCY REVIEW � '%/�/
/ CASH/CK#
TOTAL / I s 66 DATE c.3 IS.
/0 3
*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.
g:\permitcenter\forms\bldg formstnstall-revised 10-23-02.doc