HomeMy WebLinkAboutBLD2003-00213 • •
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 #: BLD03-00213 Received Date 4/3/2003
SITE ADDRESS: 1734 OAK BAY RD Issue Date 4/4/2003
PORT HADLOCK, 98339
APPLICANT: KENNETH A MC MILLEN PHONE: 360-385-4439
PO BOX 368
PORT HADLOCK WA 983390368
T 28
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 921073009 Section: 7 Township: 29N Range: 01 E
CONTRACTOR: FERRELLGAS PHONE: 1-888-933-7735
PO BOX 67
HOODSPORT WA 98548
Contractor's License FERRELP055LH Expires 08/01/2004
OWNER, KENNETH A MC MILLEN PHONE: 360-385-4439
if different: PO BOX 368
PORT HADLOCK WA 983390368
PROJECT DESCRIPTION: UNDERGROUND PROPANE TANK
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 04/04/2004.
REQUIRED INSPECTIONS:
[ ] TankYLine/APpfiance: ,::,ste ed� lL0/1 � '03e*
[ ] FinalApproval: 4/fr�3
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 10/29/19f
ill BUILDING PERMIT APPLI1PATION BLD03-00213
Review
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00213 Received Date: 4/3/2003
SITE ADDRESS: 1734 OAK BAY RD
PORT HADLOCK, 98339
OWNER: KENNETH A MC MILLEN PHONE: 360-385-4439
PO BOX 368
PORT HADLOCK WA 983390368
SUBDIVISION: Block: Lot: T 28
PARCEL NUMBER: 921073009 Section: 7 Township: 29 N Range: 01 E
CONTRACTOR: FERRELLGAS PHONE: 1-888-933-7735
PO BOX 67
HOODSPORT WA 98548
Contractor's License FERRELPO55LH Expires 08/01/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION UNDERGROUND PROPANE TANK
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
4 3�0 Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 ZAN 04/03/03 55986
Total: $47.00
APR ® 42003
nE
Jefferson County Planning
& Building Dep ment
ot(
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
XUnderground 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):
fare7—" �.4-vCe e� ZIP -3�
/' G 9 DIGIT PARCEL ID NUMBER 2/ G 7 3 G% 7
Legal Description:
Subdivision Name Block Lot(s)
Section // Township North, Range WM
APPLICANT \lefe4,/�yC- ,/I1( er,S//P'11 PHONE iO —.��J 9 S1,3
MAILING ADDRESS ;�/73 y !/i,C 6¢� j
Poe.7 f4/I¢i)/i 4 / ZIP 9,_ 75
PROPERTY OWNER J 1'.4-.Ai�•e- 4/_ 7,0(0,�s4/ PHONE j.4 e_
MAILING ADDRESS
5 /1:if C� ZIP
CONTRACTOR -',e,e/1� -s 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.appli 's property or structure s all berequested a shall occur during regular business hours.
APPLICANTS SIGNATURE .- � _ s c��d'll DATE / (13 I v.?4t)13
t / 00- FOR OFFICE USE ONLY
BASE FEE ��• RECEIPT#--7 SS'�j
CONSISTENCY REVIEW Z3 ' SO CASH/CK# l -7 0-5
TOTAL 70 , SQ DATE L /3 /o 3
*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. 1
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