HomeMy WebLinkAboutBLD2003-00236 • •
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 #: BLD03-00236 Received Date 4/11/2003
SITE ADDRESS: 651 E PIONEER DR Issue Date 4/11/2003
PORT LUDLOW, 98365
APPLICANT: FRANCIS S MARIK PHONE: (360)437-7915
ANDREA MARIK
651 PIONEER DRIVE
PORT LUDLOW WA 98365-9668
SUBDIVISION: PORT LUDLOW NO 2 AREA 3 Block: Lot:
PARCEL NUMBER: 990600326 Section: 9 Township: 28N Range: 01 E
CONTRACTOR: WHITEY JOHNSON GENERAL CONTR PHONE: (360)779-9884
PO BOX 1110
SUQUAMISH WA 98392
Contractor's License WHITEJG159DN Expires 03/15/2005
OWNER, FRANCIS S MARIK PHONE: (360)437-7915
if different: ANDREA MARIK
651 PIONEER DRIVE
PORT LUDLOW WA 98365-9668
PROJECT DESCRIPTION: WOODSTOVE
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 04/11/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[ ] FinalApproval: LOP/ 6v001540sie tilcv3)5tAPPS OK. 5.5/03
L-NeY WCo S T6vE u PS TA QS U k 5/>5/o36
41-
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£
BLD03-00236
BUILDING PERMIT APPLI!ATION Review Typ e:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD03-00236 Received Date: 4/11/2003
SITE ADDRESS: 651 E PIONEER DR
PORT LUDLOW, 98365
OWNER: FRANCIS S MARIK PHONE: (360)437-7915
ANDREA MARIK
651 PIONEER DRIVE
PORT LUDLOW WA 98365-9668
SUBDIVISION: PORT LUDLOW NO 2 AREA 3 Block: Lot:
PARCEL NUMBER: 990600326 Section: 9 Township: 28 N Range: 01 E
CONTRACTOR: WHITEY JOHNSON GENERAL CONTR PHONE: (360)779-9884
PO BOX 1110
SUQUAMISH WA 98392
Contractor's License WHITEJG159DN Expires 03/15/2005
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION WOODSTOVE
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
`� (�3 Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 ZAN 04/11/03 56016
Total: $47.00
JEFFERSON COUNTY COM•TY DEVELOPMENT,621 SHERIDAN ST,PORT TEND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground 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):
'5- I Ci013P_ER e.AiL --
Q 1 L- Jrn.c Li.) i t- -) ZIP 9 6-S 6:5-
9 DIGIT PARCEL ID NUMBER
Legal Description:r—Pc ( .� c > RT I'34
Subdivision Named t Block Lot(s)
Section Township\ North, Range WM
APPLICANT T(R F1-I`' C ` VV� 1 F� PHON b 6 11 ��I -4-I -1 ( ,3
y �
MAILING ADDRESS J N 10 E s----FR -C -l. rRrR--1-- 4--•-) 1,EL' ) jJ W. ZIP gi --- C
PROPERTY OWNER Of . -.31`.4-..._-.. PHONE
MAILING ADDRESS
401-4Q � , 1 ZIP r�� �7QCONTRACTOR J h-� PHON -�C7 t-' 1 1 ss1 �1i
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 a ntry to Jefferson County a ''s employees,representatives or agents for the purpose of application review and any required later
inspections. Access and right of entry .e appllii(caant'�slproperty pr stru ure hall be regtie ed and shall occur during regular business hours. i (�`�,
APPLICANTS SIGNATURE �/�'`"`LA �, ------\
DATE / 11 / `-3
Li/. FOR OFFICE USE ONLY
BASE FEE RECEIPT#
CONSISTENCY REVIEW CASH/CK#
TOTAL WaL 0112 DATE / /
*Underground Propane Tank applications require additional information to be submitted. 0 V E R ll
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