HomeMy WebLinkAboutBLD2003-00135 • •
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#: BLD03-00135 Received Date 3/4/2003
SITE ADDRESS: 41-4 HIGHLAND GREENS Issue Date 3/7/2003
PORT LUDLOW, 98365
APPLICANT: CLYDE S PAGE PHONE: (360)437-7875
PO BOX 65273
PORT LUDLOW WA 98365-0273
SUBDIVISION: HIGHLAND GREENS Block: Lot:
PARCEL NUMBER: 959500035 Section: 21 Township: 28N Range: 01 E
CONTRACTOR: DOWN RIGHT COZY PHONE: (253)691-7518
27877 RESOURCE RIDGE AVE NE
KINGSTON WA 98346
Contractor's License DOWNRC*985JT Expires 4/30/2003
OWNER, CLYDE S PAGE PHONE: (360)437-7875
if different: PO BOX 65273
PORT LUDLOW WA 98365-0273
PROJECT DESCRIPTION: HEAT STOVE & GAS 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 3/7/2004.
REQUIRED INSPECTIONS:
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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
03UILDING Review T Ty PERMIT APPLIC�ON BL y135
pe:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD03-00135 Received Date: 3/4/2003
SITE ADDRESS: 41-4 HIGHLAND GREENS
PORT LUDLOW, 98365
OWNER: CLYDE S PAGE PHONE: (360)437-7875
PO BOX 65273
PORT LUDLOW WA 98365-0273
SUBDIVISION: HIGHLAND GREENS Block: Lot:
PARCEL NUMBER: 959500035 Section: 21 Township: 28 N Range: 01 E
CONTRACTOR: DOWN RIGHT COZY PHONE: (253)691-7518
27877 RESOURCE RIDGE AVE NE
KINGSTON WA 98346
Contractor's License DOWNRC*985JT Expires 4/30/2003
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION HEAT STOVE & GAS PIPING
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
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 55123
Total: $47.00
JFFEIISON COUNTY COMMUNEVELOPMENT,621 SHERIDAN ST,PORT TOWNIIND 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 f\, HEAT STOVE HOT WATER TANK
,/WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE
/` OTHER(Please Specify) jay 10/l
Is this appliance(htg stove,(hot water tank,furnace, etc.)to be installed in a Manufactured/Mobile Home?
YES NO
SITE ADDRESS(911##1 Road Name):
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/gy•",z�cc a�.-e0 t c,3 W4 ZIP n'34 6`
9 DIGIT PARCEL ID NUMBER ,9.5-Y 7®4-- ,ry 7.-:i
Legal Description:
Subdivision Name Block Lot(s)
n/Section Township North, Range WM
APPLICANT 4` �� J4.Qq PHONE 3( CO h13) 71'76
MAILING ADDRESS ,,. D. -x i v6 5 Z2 3
,.l d-4,0(-0 IA./4 ZIP 9 b''3� S'"
PROPERTY OWNER PHONE
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MAILING ADDRESS
,,��/�JJ J�^ ZIP
CONTRACTOR ia�i /4 ✓C q S,oQ PHONE
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 entr to e applican 's property or structure shall be requested and shall occur during regular business hours.
APPLICANT'S SIGNATURE t7' DATE / /
FOR OFFICE USE ONLY
BASE FEE Li 3.
'C RECEIPT# S S1 Z3
CONSISTENCY REVIEW CASH/CK# 54a///
TOTAL -1' - (i V DATE ,/q / V3
*Underground Propane Tank applications require additional information to be submitted. 0 V EAR
Please contact our office at 360-379-4450 if the back of this application is blank. IIMIk
H:\HOME\PLNCNTR\INFOBLDG\FORMS\I NSTALL.DOC
MAR - 4 2003