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HomeMy WebLinkAboutBLD2003-00253 • 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 #: BLD03-00253 Received Date 4/22/2003 SITE ADDRESS: 40 GENE ST Issue Date 4/22/2003 CHIMACUM, 98325 APPLICANT: DELLA MAE E GREENE-LOWE PHONE: (360)385-4591 PO BOX 779 PORT HADLOCK WA 98339-0779 SUBDIVISION: Block: Lot: PARCEL NUMBER: 901101017 Section: 10 Township: 29N Range: 01W CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CENEXHS022NQ Expires 9/6/2004 OWNER, DELLA MAE E GREENE-LOWE PHONE: (360)385-4591 if different: PO BOX 779 PORT HADLOCK WA 98339-0779 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 4/22/2004. REQUIRED INSPECTIONS: tATERid [ ] C/Lin- A ppliance: 6K 4/Z8/3 [ ] Fi Approval: 07` ¢/z_B f 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 ,PERMIT 10/29/19 41C UILDING PERMIT APPLICAON BLD03-00253Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD03-00253 Received Date: 4/22/2003 SITE ADDRESS: 40 GENE ST CHIMACUM, 98325 OWNER: DELLA MAE E GREENE-LOWS PHONE: (360)385-4591 PO BOX 779 PORT HADLOCK WA 98339-0779 SUBDIVISION: Block: Lot: PARCEL NUMBER: 901101017 Section: 10 Township: 29 N Range: 01 W CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CENEXHS022NQ Expires 9/6/2004 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: 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 Shoreline Aquifer Forest: Commercial Rural Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $47.00 MAM 04/22/03 56158 Total: $47.00 JEFFERSON COUNTY COMMUN•EVELOPMENT,621 SHERIDAN ST,PORT TOWN WA 98368 PH: (360)379-4450 INSTALLATION PERMIT_A_PPLICATION MARK ALL ITEMS BELOW THAT PERTAI IS INSTAL Underground PROPANE TANK* Above Ground PROPANE TAN EATST6vE HOT WATER TANK WOODSTOVE FIREPLACE INSER T STOVE COOKING STOVE OTHER(Please Specify) Is this appliance(htg stove, hot water tank,furnace, etc.)to be installed in a Manufactured/�M bile Home? X YES NO SITE ADDRESS(911#/Road dName): 4o Ue cj r T(,' . Not)t)Itr /� ZIP 76f-3 9 DIGIT PARCEL ID NUMBER 9e/ /O / 03 Legal Description: Subdivision Name Block Lot(s) Section Township North, Range WM APPLICANT PHONE MAILING ADDRESS /� o� ZIP (���' �� PROPERTY OWNER S 7 40 LA.) PHONE f O-a l J MAILING ADDRESS P 0. /O>C / ]/ 9 /fiC� `� i�D 1'- ZIP 9 CONTRACTOR Ce-/Ve.,y,X / OO. y s- I Y"Cr PHONE / 3Z- - S l�SS MAILING ADDRESS P.-D: GOY e c ,/ ific ,n-. r a/ 1' • ZIP 9/ z s STATE LICENSE# CCs iex H_O z-2- N Q EXP.DATE© /06/0 V FEDERAL I.D.# ! `"' 40D /09J� 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 DATE / / LtI J BASE FEE 2 FOR OFFICE USE ONLY RECEIPT# SCQ 1 5 g CONSISTENCY REVIEW ,^ el CK# / TOTAL I q ' ) DATE "1l /�y/ O. *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\bidg forms\install-revised 10-23-02.doc