HomeMy WebLinkAboutBLD2003-00167 111/ 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 #: BLQo3-00167 Received Date 3/14/2003
SITE ADDRESS: 61 HANDLER CT Issue Date 3/14/2003
PORT LUDLOW, 98365
APPLICANT: JACK A MC KAY PHONE:
JUDY K MC KAY
10412 PACIFIC ST APT 204
OMAHA NE 681144747
SUBDIVISION: INNER HARBOR VILLAGE CONDOS Block: Lot:
PARCEL NUMBER: 961600404 Section: 17 Township: 28N Range: 01 E
CONTRACTOR: EMERALD HEARTH AND HOME PHONE: 385-5797
20714 SR 305
POULSBO WA 98370
Contractor's License SUNSHP*077QP Expires 11/17/2004
OWNER, JACK A MC KAY PHONE:
if different: JUDY K MC KAY
10412 PACIFIC ST APT 204
OMAHA NE 681144747
PROJECT DESCRIPTION INSTALL FIREPLACE INSERT AND 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 03/14/2004.
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
i:\F_BLD_Permit_Propane.rpt 10/29/19
*BUILDING PERMIT APPLICOION BLD03-00167
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLg03-00167 Received Date: 3/14/2003
SITE ADDRESS: 61 HANDLER CT
PORT LUDLOW, 98365
OWNER: JACK A MC KAY PHONE:
JUDY K MC KAY
10412 PACIFIC ST APT 204
OMAHA NE 681144747
SUBDIVISION: INNER HARBOR VILLAGE CONDOS Block: Lot:
PARCEL NUMBER: 961600404 Section: 17 Township: 28 N Range: 01 E
CONTRACTOR: EMERALD HEARTH AND HOME PHONE: 385-5797
20714 SR 305
POULSBO WA 98370
Contractor's License SUNSHP*077QP Expires 11/17/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIO INSTALL FIREPLACE INSERT AND 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
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 03/14/03 55098
Total: $47.00
JEFFERSON COUNTY COMMUI.DEVELOPMENT,621 SHERIDAN ST,PORT TOWIIIIID 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):
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9 DIGIT PARCEL ID NUMBER 9 et
Legal Description: G
Subdivision Name Block Lot(s)
j�Seection M Township North, Range( 1 ( WM
APPLICANT / . C Ali PHONE " 1 g`�-�
MAILING ADDRESS C 1'..� A CI_L/�, ,�, ! ,y`
_I r r �1n-/�t l r , ZIP c llJf �6j 5'
PROPERTY OWNER �,I `-'�-' ► ' 1� L G� PHONE `t'� b t ( ko
MAILING ADDRESS 4 r 1, .1 1 rC� L e,�"
j �.'' t- ""� �-�1.,u. ZIP q �``74�5
CONTRACTOR K-� W EfC L td L4 -4/Y1 * -�� '"'"� PHONE �--� ` L[ -)(tC=°)
MAILING ADDRESS )--1 t 4 l' L l-� E.
1
ID(AA.S (3C- L,C-�4-' ZIP S 31 V
STATE LICENSE# £wt ' ' `A hi N 6)at CD 1 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 Count and it's employees, representatives or agents for the purpose of application review and any
required later inspections. Access a •ght of ntry to the a • nt's p perty or structure shall be requested and shall occur during regular business hours.
APPLICANT'S SIGNATURE DATE / I '-C / (-,)�
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*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. Mil*
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