HomeMy WebLinkAboutBLD2003-00239 • •
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 #: BLD03-00239 Received Date 4/14/2003
SITE ADDRESS: 4941 SR 20 Issue Date 4/14/2003
PORT TOWNSEND, 98368
APPLICANT: ROBERT P LANDIS PHONE:
CYNTHIA L GRUYE
4943 STATE ROUTE 20
PORT TOWNSEND WA 983689'701 T 1+
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 901054004 Section: 5 Township: 29N Range: 01W
CONTRACTOR: KIMBALL & LANDIS LLC PHONE: (360)385-4915
151 FREDRICK ST
PORT TOWNSEND WA 98368
Contractor's License KIMBALL996D3 Expires 03/25/2004
OWNER, ROBERT P LANDIS PHONE:
if different: CYNTHIA L GRUYE
4943 STATE ROUTE 20
PORT TOWNSEND WA 983689701
PROJECT DESCRIPTION: ABOVE GROUND PROPANE TANK, HEAT STOVE, COOKING
STOVE
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 04/14/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[1] FinalApproval ,$- /Q 91
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£
BUILDING PERMIT APPL•TION BLD03-00239
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00239 Received Date: 4/14/2003
SITE ADDRESS: 4941 SR 20
PORT TOWNSEND, 98368
OWNER: ROBERT P LANDIS PHONE:
CYNTHIA L GRUYE
4943 STATE ROUTE 20
PORT TOWNSEND WA 983689701
SUBDIVISION: Block: Lot: T 1+
PARCEL NUMBER: 901054004 Section: 5 Township: 29 N Range: 01 W
CONTRACTOR: KIMBALL & LANDIS LLC PHONE: (360)385-4915
151 FREDRICK ST
PORT TOWNSEND WA 98368
Contractor's License KIMBALL996D3 Expires 03/25/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION ABOVE GROUND PROPANE TANK, HEAT STOVE, COOKING STOVE
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
l D3 Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 ZAN 04/14/03 56019
Total: $47.00
JEFFERSON COUNTY coFJITY DEVELOPMENT,621 SHERIDAN ST,PORT 11111SEND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
i
Underground PROPANE TANK* _,_Above Ground PROPANE TANK 2 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?,.
-----ram
YES ( NO )
SITE ADDRESS(911#/Road Name):
q47?-)
ZIP
9 DIGIT PARCEL ID NUMBER 9 0 C) 4
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range VVM
h
APPLICANT �`35=� 1-� 71 S PHONE J 2
MAILING ADDRESS q j
( Q . ZIP
PROPERTY OWNER < PHONE
MAILING ADDRESS
ZIP
CONTRACTOR <> 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 Jeffers County and it mplo s, representatives or agents for the purpose of application review and any
required later inspections. Access and right of entry to the applic nt's property o struct re shall be requested and shall occur during regular business hours.
APPLICANT'S SIGNATURE �- DATE 'l / /` 7
FOR OFFICE USE ONLY
BASE F E l IPT
CONSI NC REVIEW CASH/CK#
TOTAL
*Underground Propane Tank applications require additional information to be submitted. OVER
Please contact our office at 360-379-4450 if the back of this application is blank.
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