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Home My WebLink AboutBLD2003-00277 • • 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 #: BLD03-00277 Received Date 5/6/2003 SITE ADDRESS: 214 S BAY LN Issue Date 5/6/2003 PORT LUDLOW, 98365 APPLICANT: DAVID A JOHNSON PHONE: 360-437-7766 SANDRA JOHNSON 214 S BAY LN PORT LUDLOW WA 98365-9562 16 SUBDIVISION: LUDLOW POINT VILLAGE DIV 1 Block: Lot: PARCEL NUMBER: 969400016 Section: 16 Township: 28N Range: 01 E CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTPI983O6 Expires 09/26/2004 OWNER, DAVID A JOHNSON PHONE: 360-437-7766 if different: SANDRA JOHNSON 214 S BAY LN PORT LUDLOW WA 98365-9562 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 05/06/2004. REQUIRED INSPECTIONS: 6 � [';I Tank/Line/Appliance: /AN,K1 l i i. SASA/1JEr5, aP f i i c e tjne l I FinalApproval: ®K r- C d / 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 UILDING PERMIT APPLICON BLD03-00277Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD03-00277 Received Date: 5/6/2003 SITE ADDRESS: 214 S BAY LN PORT LUDLOW, 98365 OWNER: DAVID A JOHNSON PHONE: 360-437-7766 SANDRA JOHNSON 214 S BAY LN PORT LUDLOW WA 98365-9562 SUBDIVISION: LUDLOW POINT VILLAGE DIV 1 Block: Lot: 16 PARCEL NUMBER: 969400016 Section: 16 Township: 28 N Range: 01 E CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTPI983O6 Expires 09/26/2004 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr 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 CJZ 05/06/03 56127 Total: $47.00 JEFFERSON COUNTY COMMUN DEVELOPMENT,621 SHERIDAN ST,PORT TOWI D WA 98368 PH: (360)379-4450 INSTALLATION PERMIT APPLICATION MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION Underground PROPANE TANK* 1.• Above Ground PROPANE TANK 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 Name): 2 //I Sou]-1i Bay Leitle Po h f l—ucliocej ZIP 9�135 9 DIGIT PARCEL ID NUMBER '6 q -/lcc --04 Legal Description: Subdivision Name 4 ud'act) Pa/y7 1/'11 je. Div. 1 Block Lot(s) /6 Section U Township North, Range WM APPLICANT / J, Ci C�Q(/I�� >�/�t)r6�,.5'(J{7 PHONE �.3� "7��i Z MAILING ADDRESS /� 56!Jill Bay L-uki-e pai4 Lud/UCoJ ZIP 9c5'3di- PROPERTY OWNER °a v/ i A , Ja17i5,-jN PHONE Same MAILING ADDRESS ESQ d1? ZIP CONTRACTOR 721 Cvt:1 & o-�� PHONE seJ� D cr/t'7` 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 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 pr erty or structure all be requested and shall occur during regular business hours. APPLICANT'S SIGNATURE ��rr �° C,9�%�C4-49` DATE :c / �, /� FOR OFFICE USE ONLY ln BASE FEE 1-1 RECEIPT# 7 CONSISTENCY REVIEW CASH/CK# C 3 t TOTAL 1 O U DATE . /___42_/Q'� *Underground Propane Tank applications require additional information to be submitted. 0 V E R 0. 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