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HomeMy WebLinkAboutBLD2003-00238 110 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 #: BLD03-00238 Received Date 4/14/2003 SITE ADDRESS: 91 MARTINGALE PL Issue Date 4/14/2003 PORT LUDLOW, 98365 APPLICANT: BEVERLY A CLEMENTS TRUSTE PHONE: (360)437-9731 B CLEMENTS TRUST AGREEMEN 91 MARTINGALE PL PORT LUDLOW WA 98365-9559 45 SUBDIVISION: BAYVIEW VILLAGE DIV 3 Block: Lot: PARCEL NUMBER: 931900045 Section: 16 Township: 28N Range: 01E CONTRACTOR: PETTIT OIL CO PHONE: (360)385-1420 PO BOX 1031 PORT TOWNSEND WA 98368 Contractor's License PETTIOCO88CC Expires 5/1/2004 OWNER, BEVERLY A CLEMENTS TRUSTE PHONE: (360)437-9731 if different: B CLEMENTS TRUST AGREEMEN 91 MARTINGALE PL PORT LUDLOW WA 98365-9559 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 4/14/2004. REQUIRED INSPECTIONS: [ ] r Appliance: .08 of ,, [t.] FinalApprova I: ,e,K 42,r G/O 3/20 03 1y/ 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 APPLICN BLD03-00238 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD03-00238 Received Date: 4/14/2003 SITE ADDRESS: 91 MARTINGALE PL PORT LUDLOW, 98365 OWNER: BEVERLY A CLEMENTS TRUSTE PHONE: (360)437-9731 B CLEMENTS TRUST AGREEMEN 91 MARTINGALE PL PORT LUDLOW WA 98365-9559 SUBDIVISION: BAYVIEW VILLAGE DIV 3 Block: Lot: 45 PARCEL NUMBER: 931900045 Section: 16 Township: 28 N Range: 01 E CONTRACTOR: PETTIT OIL CO PHONE: (360)385-1420 PO BOX 1031 PORT TOWNSEND WA 98368 Contractor's License PETTIOCO88CC Expires 5/1/2004 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP 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 04/14/03 47893 Total: $47.00 0 JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNOD WA 98368 PH: (360)379-4450 INSTALLATION PERMIT APPLICATION WOODSTOVE . PROPANE TANK PELLET PELLET STOVE OTHER Is this appllai>t ePhtg strfveY�ho�tjwafer tank,furnace,etc.)to be installed in a Manufactured/Mobile Home? YES NO SITE ADDRESS(911#/Road Name): l l mal_ if- - I' �/e PI Pc.) r,- „LA... / L.)0 , ZIP q O 3 (n S 9 DIGIT PARCEL ID NUMBER '3 / a o © Y S Legal Description: Subdivision Name Block Lot(s) Section W Township North, Range M APPLICANT /26 147% / O r (/ PHONE 3 8- ;V- 0 MAILING ADDRESS 02 3 5'e/4)`L- CI 1 fG? rt- 7—Dc.e)Yuft", C. ZIP 9 .� S. PROPERTY OWNER Be d C r/Y ei- OCa-✓ i e r C l6"r,-) E-'v.. f S PHONE `-13 7 - 7 3 / MAILING ADDRESS d / ry1 ct- i //-,r ;#/� P ' PO��� �,,e-tGIU4.-e.J ZIP 7dd3C s CONTRACTOR P T7 , 0 ( PHONE 3 _/�'z O MAILING ADDRESS c 3 _5 e 14-7, .a CI , pe, i 1 i)L-r:l2 5E' I ZIP CV C' 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 applicant's property/ or structure shall be requested and shall occur during regular business hours. APPLICANT SIGNATURE (.. DATE < / a- / �� FOR OFFICE USE ONLY BASE FEE _47.00 RECEIPT# 4 8°I CASH/CK# CIA IA TOTAL DATE L/j/03 H:\HOME\PLNC NTR\I N FOBLDG\FORMS\I N STALL.DOC 11/05/01