HomeMy WebLinkAboutBLD2003-00196 • •
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 #: BLD03-00196 Received Date 3/27/2003
SITE ADDRESS: 191 SHORE DR Issue Date 3/27/2003
PORT LUDLOW, 98365
APPLICANT: PAUL D FAULKNER PHONE:
JANET P FAULKNER
2537 NE 191ST ST
LAKE FOREST PARK WA 98155-2454 4-7
SUBDIVISION: PARADISE BAY ESTATES Block: 14 Lot:
PARCEL NUMBER: 983401405 Section: 23 Township: 28N Range: 01 E
CONTRACTOR: SUBURBAN PROPANE PHONE: 385-5096
P 0 BOX 989
PORT TOWNSEND WA 98368
Contractor's License SUBURPL044DA Expires 3/12/2005
OWNER, PAUL D FAULKNER PHONE:
if different: JANET P FAULKNER
2537 NE 191ST ST
LAKE FOREST PARK WA 98155-2454
PROJECT DESCRIPTION: PROPANE TANK& HEAT STOVE
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 3/27/2004.
REQUIRED INSPECTIONS:
Tan in liance: 0 k 3/'P47 -*
FinalApproval: 0e gvr- 6 /- �G
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_Propa ne.rpt 10/29/19
BLD03-00196
UILDING PERMIT APPLICAOON Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00196 Received Date: 3/27/2003
SITE ADDRESS: 191 SHORE DR
PORT LUDLOW, 98365
OWNER: PAUL D FAULKNER PHONE:
JANET P FAULKNER
2537 NE 191ST ST
LAKE FOREST PARK WA 98155-2454
SUBDIVISION: PARADISE BAY ESTATES Block: 14 Lot: 4-7
PARCEL NUMBER: 983401405 Section: 23 Township: 28 N Range: 01 E
CONTRACTOR: SUBURBAN PROPANE PHONE: 385-5096
P 0 BOX 989
PORT TOWNSEND WA 98368
Contractor's License SUBURPL044DA Expires 3/12/2005
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP PROPANE TANK & HEAT STOVE
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 03/27/03 55884
Total: $47.00
JEFFERSON COUNTY COMMUN.EVELOPMENT,621 SHERIDAN ST,PORT TOWD WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
10
Underground PROPANE TANK* ' Above Ground PROPANE TANK tl' HEAT STOVE HOT WATER TANK
i
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):
G( ke-Df _ c . p -_ L�,),10 wc . * '77. /W LI ZIP q`t-6 5
(9 DIGIT PARCEL ID NUMBER ( � `( ®/ — 4/LJ5—
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range / WM
J)
APPLICANT (- L f Pi PHONE ' 4:2 s p b o
MAILING ADDRESS 2p 1,>C l CD e
1 (,� /� ZIP � �� 6g
PROPERTY OWNER 2 t�{� /�1�v) {1��1 _ PHONE
MAILING ADDRESS 5 3 7 /YE.C, t 9 1 sT 1
2c L /G sr Ark (,)A 4
ZIP D 1 Ss-
CONTRACTOR S L) f E - IP.CyciCe:" PHONE n �0?,K7
MAILING ADDRESS Pp �( ( S 9 Q
V' Q C�
. I ut) A- ZIP / 3
STATE LICENSE# 3C )UW,,ipL >4i OA EXP.DATE 3//2/ O S.-
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 Vucture s all be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE 'i-22 C ------ DATE 3 / 2?/ (
FOR O E USE ONLY BASE FEE _ RECEIPT# 4
CONSISTENCY REVIEW � K#
TOTAL P TE
*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 forms\install-revised 10-23-02.doc