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HomeMy WebLinkAboutBLD2003-00259 0 • 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 #: BLD03-00259 Received Date 4/28/2003 SITE ADDRESS: 3520 PARADISE BAY RD Issue Date 4/28/2003 PORT LUDLOW, 98365 APPLICANT: RICHARD N CHADWICK PHONE: 360-437-2572 PATRICIA F CHADWICK 3520 PARADISE BAY RD PORT LUDLOW WA 983659253 SUBDIVISION: PARADISE BAY ESTATES Block: Lot: PARCEL NUMBER: 983401203 Section: 22 Township: 28N Range: 01 E CONTRACTOR: FERRELLGAS PHONE: (360)582-0231 646 SO 3RD AVE SEQUIM WA 98382 Contractor's License FERRELP055LH Expires 08/01/2004 OWNER, RICHARD N CHADWICK PHONE: 360-437-2572 if different: PATRICIA F CHADWICK 3520 PARADISE BAY RD PORT LUDLOW WA 983659253 PROJECT DESCRIPTION: PROPANE TANK AND HEAT 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 04/28/2004. REQUIRED INSPECTIONS: [ ] t ir A pplianc QX 0V4,;' [ ] ctin OK 4/03 ,471 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 APPLIS,TION BLD03-00259 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD03-00259 Received Date: 4/28/2003 SITE ADDRESS: 3520 PARADISE BAY RD PORT LUDLOW, 98365 OWNER: RICHARD N CHADWICK PHONE: 360-437-2572 PATRICIA F CHADWICK 3520 PARADISE BAY RD PORT LUDLOW WA 983659253 SUBDIVISION: PARADISE BAY ESTATES Block: Lot: PARCEL NUMBER: 983401203 Section: 22 Township: 28 N Range: 01 E CONTRACTOR: FERRELLGAS PHONE: (360)582-0231 646 SO 3RD AVE SEQUIM WA 98382 Contractor's License FERRELP055LH Expires 08/01/2004 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION PROPANE TANK AND HEAT 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 Shoreline Aquifer Forest: Commercial Rural Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $47.00 ZAN 04/28/03 56119 Total: $47.00 JEFFERSON COUNTY COMFY DEVELOPMENT,621 SHERIDAN ST,PORT TO ' END WA 98368 PH: (360)379-4450 INSTALLATION PERMIT APPLICA N MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION Underground PROPANE TANK* \ Above Ground PROPANE TANK ` 1 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 me): a,� , � Ad PvLG>�'.4l i 2�/ l.©��y/"� -7 ZIP 9 cJ 4=(, L5. 9 DIGIT PARCEL ID NUMBER QQQ / . /0{c r j Legal Description: , ) Subdivision Name afaik � seE -` j �u Block / Lot(s) )Section /Uyy� Township North, Range WM WM APPLICANT /J/dC d' Cam//✓L'�t�/ee PHONEa �fG�' �7�577 MAILING ADDRESS aC7 &tad/6e. nCc /C r—,& / / 2 l-(FlG` _1n % ✓ e2' ZIP PROPERTY OWNER •(,/(kidQ- �d2 0'? PHONE MAILING ADDRESS ZIP / �J CONTRACTOR ( , ,s7,"/ 2� PHONEo3 17 779 Jo' Ol MAILING ADDRESS J'i>,t1' 7 "�i/oy , o4-7 . J4t!7 iO ZIP ��7` 70 , U STATE LICENSE# AJ L r9",5 7 2 2 '£'r 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 ri to effer n County an, it'( ployees,representatives or agents for the purpose of application review and any required later inspections. Access and right of a tot ppli nt's pe y/isu ure be quested and shall occur during regular business hours. APPLICANTS SIGNATURE L ` DATE `'' / ,5 /Z7,-.:3 FOR OFFICE USE ONLY BASE FEE -11 a" RECEIPT# t� (0 i (7 CONSISTENCY REVIEW CASH/CK# I c�/ / 3 TOTAL 00 DATE "T icRE /0 13 *Underground Propane Tank applications require additional information to be submitted. OVER0. 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