HomeMy WebLinkAboutBLD2003-00189 • i
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 #: BLD03-00189 Received Date 3/25/2003
SITE ADDRESS: 133 CEDARVIEW DR Issue Date 3/25/2003
PORT TOWNSEND, 98368
APPLICANT: HAROLD D GLANTZ TRUSTEE PHONE:
EVE R GLANTZ TRUSTEE
133 CEDAR VIEW DR
PORT TOWNSEND WA 983689527 200
SUBDIVISION: KALA POINT#9 Block: Lot:
PARCEL NUMBER: 965000340 Section: 27 Township: 30N Range: 01W
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 9/6/2004
OWNER, HAROLD D GLANTZ TRUSTEE PHONE:
if different: EVE R GLANTZ TRUSTEE
133 CEDAR VIEW DR
PORT TOWNSEND WA 983689527
PROJECT DESCRIPTION: PROPANE TANK INSTALLATION
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 3/25/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:' 6
[ FinalApproval. 6 `0
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_Perm it_Propane.rpt 10/29/19
• BUILDING PERMIT APPATION B RD03-00189
eview Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00189 Received Date: 3/25/2003
SITE ADDRESS: 133 CEDARVIEW DR
PORT TOWNSEND, 98368
OWNER: HAROLD D GLANTZ TRUSTEE PHONE:
EVE R GLANTZ TRUSTEE
133 CEDAR VIEW DR
PORT TOWNSEND WA 983689527
SUBDIVISION: KALA POINT#9 Block: Lot: 200
PARCEL NUMBER: 965000340 Section: 27 Township: 30 N Range: 01 W
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 9/6/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION PROPANE TANK INSTALLATION
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
Z� O Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 PRB 03/25/03 55971
Total: $47.00
JEFFERSON COUNTY COMMOY DEVELOPMENT,621 SHERIDAN ST,PORT TO•ND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* V Above Ground PROPANE TANK HEAT STOVE HOT WATER TANK
WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE IS **alga&
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):
I;, 0&Meta. t/'i�'14 P1? : G�
7UR-7 7 a e,0#0siN',7 ZIP PR e
+
9 DIGIT PARCEL ID NUMBER l 6 5—O P9 A . 4 d
Legal Description:
Subdivision Name KA LA o / Al r Block Lot(s) 2 & 0
Section Township North, Range WM
APPLICANT 44 hL D ( ;C MJ 7 2-- PHONE 3 C a — 3 7 r- 93 7c
MAILING ADDRESS /3 3 c.9 A-A 0 if A.) 1 . C�
"o/ i ausM5I iy ZIP / 83‘8
PROPERTY OWNER jiQ A4 e PHONE
,A
MAILING ADDRESS •5 4 iL4 5
/� ZIP
CONTRACTOR (_,.'. /0 < 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 entry to the plicant's property structure shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE DATE 5 / Z d / o I
7 -�lJ�\ FOR OFFICE USE ONLY RECEIPT# 7 l
BASE FEE
CONSISTENCY REVIEW t CASH/CK# tQ
`7
TOTAL �( 0 D DATE 3 / O 3
*Underground Propane Tank applications require additional information to be submitted. 0 V E R 10.
Please contact our office at 360-379-4450 if the back of this application is blank.
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