HomeMy WebLinkAboutBLD2003-00171 110
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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 #: BLD03-00171 Received Date 3/18/2003
SITE ADDRESS: 752 N JACOB MILLER RD Issue Date 3/18/2003
PORT TOWNSEND, 98368
APPLICANT: THOMAS E DUKE PHONE:
752 N JACOB MILLER RD
PORT TOWNSEND WA 983689214
1-8
SUBDIVISION: TIBBALS LAKE PARK Block: 61 Lot:
PARCEL NUMBER: 999006101 Section: 32 Township: 31N Range: 01W
CONTRACTOR: FERRELLGAS PHONE: (360)582-0231
646 SO 3RD AVE
SEQUIM WA 98382
Contractor's License FERRELP055LH Expires 08/01/2004
OWNER, THOMAS E DUKE PHONE:
if different: 752 N JACOB MILLER RD
PORT TOWNSEND WA 983689214
PROJECT DESCRIPTION: HOT WATER HEATER, COOKING STOVE, DRYER
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 03/18/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[^Y FinalApproval: _C-A 02.E 0g
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
• BUILDING PERMIT APPLI TION B Review
OOpe 1
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00171 Received Date: 3/18/2003
SITE ADDRESS: 752 N JACOB MILLER RD
PORT TOWNSEND, 98368
OWNER: THOMAS E DUKE PHONE:
752 N JACOB MILLER RD
PORT TOWNSEND WA 983689214
SUBDIVISION: TIBBALS LAKE PARK Block: 61 Lot: 1-8
PARCEL NUMBER: 999006101 Section: 32 Township: 31 N Range: 01 W
CONTRACTOR: FERRELLGAS PHONE: (360)582-0231
646 SO 3RD AVE
SEQUIM WA 98382
Contractor's License FERRELP055LH Expires 08/01/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION HOT WATER HEATER, COOKING STOVE, DRYER
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:
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 Bv: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 ZAN 03/18/03 55906
Total: $47.00
JEFFERSON COUNTY COMITY DEVELOPMENT,621 SHERIDAN ST,PORT T•SEND 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 FIREP CE INSERT PELLET STOVE ) COOKING STOVE
OTHER(Please Specify) Oft Y& P
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):
7.S z �c _4,b /n/LLE/L RO
r 1 itfr 7{i V1ftv, 4 FT--iN'/a 14 A— ZIP {1.Y 76
9 DIGIT PARCEL ID NUMBER
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT /4// fe) V/( PHONE 9 d' i 3 g=5- 717
MAILING ADDRESS -7 c . — /✓ , 7- s4 17 -i --r2_ /?o
`` ZIP
PROPERTY OWNER rj r?r-1'1^'C PHONE
MAILING ADDRESS
^ /� ZIP
CONTRACTOR / 1/LC C CG(5 di.-J 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 ent 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 plica ' erty or structure shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE , /,! 4��Ze%'- DATE 3 / 4 / cd'
t/ FOR OFFICE USE ONLY
BASE FEE RECEIPT#
CONSISTENCY REVIEW CASH/CK#
TOTAL DATE / /
*Underground Propane Tank applications require additional information to be submitted. 0 V E R
Please contact our office at 360-379- 450 if the back of this application is blank.
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