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HomeMy WebLinkAboutBLD2003-00248 • • 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 #: BLD03-00248 Received Date 4/18/2003 SITE ADDRESS: 293 FLEET DR Issue Date 4/18/2003 PORT LUDLOW, 98365 APPLICANT: MAELYN M MC KINLEY PHONE: WILLIAM MC KINLEY 1069 SW HILLCREST RD SEATTLE WA 98166 SUBDIVISION: PORT LUDLOW NO 2 AREA 3 Block: Lot: PARCEL NUMBER: 990603172 Section: 9 Township: 28N Range: 01 E CONTRACTOR: A PLUS ONE INC PHONE: (360)437-0218 50 GAMBLE LN PORT LUDLOW WA 98365 Contractor's License APLUSOI997R7 Expires 12/27/2003 OWNER, MAELYN M MC KINLEY PHONE: if different: WILLIAM MC KINLEY 1069 SW HILLCREST RD SEATTLE WA 98166 PROJECT DESCRIPTION: ABOVE GROUND PROPANE TANK AND FIREPLACE INSERT 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 04/18/2004. REQUIRED INSPECTIONS: [ [ dreipplianc!) 4,/,/ / � [ ] Fin- •pproval or 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 APPLITION B Review OO248 Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD03-00248 Received Date: 4/18/2003 SITE ADDRESS: 293 FLEET DR PORT LUDLOW, 98365 OWNER: MAELYN M MC KINLEY PHONE: WILLIAM MC KINLEY 1069 SW HILLCREST RD SEATTLE WA 98166 SUBDIVISION: PORT LUDLOW NO 2 AREA 3 Block: Lot: PARCEL NUMBER: 990603172 Section: 9 Township: 28 N Range: 01 E CONTRACTOR: A PLUS ONE INC PHONE: (360)437-0218 50 GAMBLE LN PORT LUDLOW WA 98365 Contractor's License APLUSO1997R7 Expires 12/27/2003 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION ABOVE GROUND PROPANE TANK AND FIREPLACE INSERT 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 y fi U 3 Shoreline Aquifer Forest: Commercial Rural Type Amount Paid Bv: Date: Receipt: Approved/Date Propane Tanks/Stoves $47.00 ZAN 04/18/03 56106 Total: $47.00 JEFFERSON COUNTY COMITY DEVELOPMENT,621 SHERIDAN ST,PORT T•SEND WA 98368 PH: (360)379-4450 INSTALLATION PERMIT APPLICATION MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION Underground PROPANE TANK* ,AAbove Ground PROPANE TANK HEAT STOVE HOT WATER TANK WOODSTOVE X FIREPLACE INSERT PELLET STOVE COOKING STOVE OTHER(Please Specify) Is this appliance (htg stove, hot water tank,furnace, etc.) to be installed in a Manufactured/Mobile Home? YES >-( NO SITE ADDRESS(911#/Road Name): q lee, ,Prl ve Pori- �(✓d//#i ZIP gk3 (�'S 9 DIGIT PARCEL ID NUMBER q I © (l� O 3 / 7 Legal Description: Subdivision Name Block Lot(s) / 7,? Section / Township North, Range WM APPLICANT �(eLt(v( ,//�"Kiv //e2j PHONE d72 -a yd - I, (o MAILING ADDRESS l�(QGf Sub /r"7 llC!>t°SJJ- �i2/ UL �y Seattle (H/9- ZIP '9d f("�j PROPERTY OWNER .5 .n4_Q PHONE MAILING ADDRESS p ZIP CONTRACTOR l`i ji'i'(,/ /.,, e �- //C i S t�y1 e PHONE MAILING ADDRESS 50 `f6�/,,ix, L'i Petit Lv(/f iea.) , ZIP k-��'-$ 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. APPLICANTS SIGNATURE ''W'�21 i' DATE l / /9' 1 3 FOR OFFICE USE ONLY BASE FEE RECEIPT# CONSISTENCY REVIEW CASH/CK# TOTAL DATE / / *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. g:\permitcenter\forms\bldg forms\install-revised 10-23-02.doc