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HomeMy WebLinkAboutBLD2003-00200 • • 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 #: BLD03-00200 Received Date 3/28/2003 SITE ADDRESS: 5925 CAPE GEORGE RD Issue Date 3/28/2003 PORT TOWNSEND, 98368 APPLICANT: PATRICK R DE MARS PHONE: DEE A DE MARS PO BOX 240236 DOUGLAS AK 99824-0236 SUBDIVISION: DISCOVERY RIDGE DIV II Block: Lot: PARCEL NUMBER: 001195008 Section: 19 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, PATRICK R DE MARS PHONE: if different: DEE A DE MARS PO BOX 240236 DOUGLAS AK 99824-0236 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 3/28/2004. REQUIRED INSPECTIONS: [ ] -6nk/Line/Appliance of:A 4y FinalApproval:2‹. V/A, 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 APPLICAON BLD03-00200 view Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD03-00200 Received Date: 3/28/2003 SITE ADDRESS: 5925 CAPE GEORGE RD PORT TOWNSEND, 98368 OWNER: PATRICK R DE MARS PHONE: DEE A DE MARS PO BOX 240236 DOUGLAS AK 99824 0236 SUBDIVISION: DISCOVERY RIDGE DIV II Block: Lot: PARCEL NUMBER: 001195008 Section: 19 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 DESCRIPTIOI 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: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: 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 03/28/03 55890 Total: $47.00 0 • JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNSEND WA 98368 PH: (360)379-4450 s>(' INSTALLATION PERMIT APPLICATION WOODSTOVE Above Ground PROPANE TANK PELLET STOVE OTHER 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): 45.9 2 S CJ9�- Ge ,z e- RD . P51UIUSUP, WA ZIP 9O J Lg C 9 DIGIT PARCEL ID NUMBER 00 it 9S —D0 U Legal Description: Subdivision Name Block Lot(s) Section Township North, Range WM APPLICANT PHONE MAILING ADDRESS ZIP PROPERTY OWNER D&& /PI 7- rn .112'rS PHONE : - 33 / / MAILING ADDRESS P. 0 . a/� 1` 3L0, - a,/e R5 t /�7n Q K ZIP / 982 471/ CONTRACTOR Ge&)CX h/i90 c. -r- 1=e-.� PHONE / 32 " J 3--r..... MAILING ADDRESS ��0, 1 ' y g /in J(lat 04_,l j_,t/4 ZIP J©P Y Leis STATE LICENSE# C e-tue-"zhef S 0 la A/Q EXP.DATE 09 j040/t//7 FEDERAL I.D.# 47' / .-6 a^s o 9J 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 structure shall be requested and shall occur during regular business hours. APPLICANT SIGNATURE DATE / / FOR OFFICE USE ONLY ((---�(7���� BASE FEE RECEIPT# � b-t, C7 CASH/CK# TOTAL DATE /d"C4/ O H:\TOME\PLNCNTR\INFOBLDG\FORMS\INSTALL.DOC11/05/01