HomeMy WebLinkAboutBLD2003-00234 "'BUILDING
UILDING PERMIT APPLICANON BL Review T Ty234
ype:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00234 Received Date: 4/11/2003
SITE ADDRESS: 90 BELVEDERE DR
PORT TOWNSEND, 98368
OWNER: FREDRICK W SPANN PHONE: (360)379-0281
DELORES L SPANN
90 BELVEDERE
PORT TOWNSEND WA 98368
SUBDIVISION: KALA POINT#5 Block: Lot: 242
PARCEL NUMBER: 965000130 Section: 27 Township: 30 N Range: 01 W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP COOKING STOVE & GAS PIPE
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 04/11/03 47880
Total: $47.00
. JEFFERSON COUNTY COMMUNODEVELOPMENT,621 SHERIDAN ST,PORT TOWISD WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TOI THIS INSTALLATION
Underground PROPANE TANK* Above Ground PROPANE TANK HEAT STOVE HOT WATER TANK
WOODSTOVE FIREPLACE INSERT PELLET STOVE R COOKING STOVE
AOTHER(Please Specify) T.I4 p If?
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):
q0f ZIP C1 f} C �
9 DIGIT PARCEL ID NUMBER L b 5 Q 00 1 3 a
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT FA ' cQ S(3 rin PHONE 279 0 --d'/
MAILING ADDRESS S 15t_c__
• ZIP
PROPERTY OWNER cZ L4-y,.4- PHONE
MAILING ADDRESS /
�((�� � I- , Un ZIP
CONTRACTOR C L_- 6'�"� & Pi,_4 p cwt. _ PHONE
MAILING ADDRESS lags.? 04-0 --+-1 1J 1--' , 1
Pr--i J. W.- ZIP q'833{�
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STATE LICENSE# S '1.5010 077 4P EXP. DATE 1 1 r 6(I
FEDERAL I.D.# (( - 1 07 c 157
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�o,/f entry to he applicant's property or structure shall be requested and shall occur during regular business hours.
APPLICANT'S SIGNATURE o�G , kl(\- DATE y / C / v 3
FOR OFFICE USE ONLY jj �
BASE FEE RECEIPT# -t-q-g RC)
CONSISTENCY REVIEW CASH/CK# ,9 ()
t
TOTAL DATE —( / , / r 3
* re a c equire additional information to be submitted. 0 V E R
PI c c rl is a 0 9 the back of this application is blank.
1
g e nter\forms\bldg forms\install-revised 1 2 doc
APR
DEPT, OF_
OOkliVuiroiY DEVELOPMENT
• •
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 #: BLD03-00234 Received Date 4/11/2003
SITE ADDRESS: 90 BELVEDERE DR Issue Date 4/11/2003
PORT TOWNSEND, 98368
APPLICANT: FREDRICK W SPANN PHONE: (360)379-0281
DELORES L SPANN
90 BELVEDERE
PORT TOWNSEND WA 98368 242
SUBDIVISION: KALA POINT#5 Block: Lot:
PARCEL NUMBER: 965000130 Section: 27 Township: 30N Range: 01W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2004
OWNER, FREDRICK W SPANN PHONE: (360)379-0281
if different: DELORES L SPANN
90 BELVEDERE
PORT TOWNSEND WA 98368
PROJECT DESCRIPTION: COOKING STOVE & GAS PIPE
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 4/11/2004.
REQUIRED INSPECTIONS:
[ ] Tank s&ppliance: Ci�N1VgG?ED ,4 vD /A) USA /(.)O L� 4I7 lf ?9 r
[ ] - ' •proval: , 04
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
i:\F_BLD_Permit_Propane.rpt 10/29/19