HomeMy WebLinkAboutBLD2003-00291 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 #: BLD03-00291 Received Date 5/9/2003
SITE ADDRESS: 204 8TH AVE Issue Date 5/9/2003
PORT HADLOCK, 98339
APPLICANT: LINDA M SHIRTS PHONE: (360)379-9813
PAUL W SHIRTS
7266 STATE ROUTE 20#20
PORT TOWNSEND WA 98368-9308 25-29
SUBDIVISION: IRONDALE Block: 54 Lot:
PARCEL NUMBER: 961805404 Section: 34 Township: 30N Range: 01W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPI983O6 Expires 9/26/2004
OWNER, LINDA M SHIRTS PHONE: (360)379-9813
if different: PAUL W SHIRTS
7266 STATE ROUTE 20#20
PORT TOWNSEND WA 98368-9308
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 5/9/2004.
REQUIRED INSPECTIONS:
Ta /Line/Appliance: M iUk *4 E.yT: 12/ -�, , Z<ti
r LAB FinalApproval: 0 K, .41-0, 5 C ���
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 APPLICIAON BLD03-00291
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00291 Received Date: 5/9/2003
SITE ADDRESS: 204 8TH AVE
PORT HADLOCK, 98339
OWNER: LINDA M SHIRTS PHONE: (360)379-9813
PAUL W SHIRTS
7266 STATE ROUTE 20#20
PORT TOWNSEND WA 98368-9308
SUBDIVISION: IRONDALE Block: 54 Lot: 25-29
PARCEL NUMBER: 961805404 Section: 34 Township: 30 N Range: 01 W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPI983O6 Expires 9/26/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION 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 MAM 05/09/03 56259
Total: $47.00
JEFFERSON COUNTY COMMUIDEVELOPMENT,621 SHERIDAN ST,PORT TOWD WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* 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):
ZIP 9 3 2
c�
9 DIGIT PARCEL ID NUMBER /C7 4.� s/qo
Legal Description:
Subdivision Name Block Lot(s)
Section
Township North, Range WM
APPLICANT �G G / 1�i/r �J PHONE
MAILING ADDRESS 7�Z�j6j I.a . 2 0/6�r— i[�a./7 c'i (7 ZIP Pk
( J S f7
PROPERTY OWNER 7'4 c4' r I PHONE -3 O J S SP'i,3
MAILING ADDRESS
ZIP
CONTRACTOR i A404 f'<A_ 1"✓'C.)/G/ 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 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
FOR OFFICE USE ONLY
BASE FEE RECEIPT# 15��2..5
CONSISTENCY REVIEW CASH/CK# /+' S!ten
TOTAL DATE / l /o 3
*Underground Propane Tank applications require additional information to be submitted. 0 V E R 10.
Please contact our office at 360-379-4450 if the back of this application is blank.
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