HomeMy WebLinkAboutBLD2003-00326 i
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 #: BLD03-00326 Received Date 5/28/2003
SITE ADDRESS: 3811 OAK BAY RD Issue Date 5/28/2003
PORT HADLOCK, 98339
APPLICANT: ROBERT L SUTHER PHONE:
AMANDA S SUTHER
PO BOX 490
PORT HADLOCK WA 983390490 3
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 921194001 Section: 19 Township: 29N Range: 01 E
CONTRACTOR: EVERWARM INC PHONE:
257151 HWY 101
PORT ANGELES WA 98362
Contractor's License EVERWI*088NL Expires 08/17/2004
OWNER, ROBERT L SUTHER PHONE:
if different: AMANDA S SUTHER
PO BOX 490
PORT HADLOCK WA 983390490
PROJECT DESCRIPTION: WOODSTOVE
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 05/28/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[ ] FinalApproval: Slrela.E ; Cl->F1puiv 0 0
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 APPLATION BLD03-0033viewe26
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00326 Received Date: 5/28/2003
SITE ADDRESS: 3811 OAK BAY RD
PORT HADLOCK, 98339
OWNER: ROBERT L SUTHER PHONE:
AMANDA S SUTHER
PO BOX 490
PORT HADLOCK WA 983390490
SUBDIVISION: Block: Lot: 3
PARCEL NUMBER: 921194001 Section: 19 Township: 29 N Range: 01 E
CONTRACTOR: EVERWARM INC PHONE:
257151 HWY 101
PORT ANGELES WA 98362
Contractor's License EVERWI*088NL Expires 08/17/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION WOODSTOVE
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: 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
1ti3 Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 ZAN 05/28/03 56247
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* 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 d'NO
SITE ADDRESS(911 #/Road Name):
33( l Ua.� Bay QQ
t ZIP eta33?
p-l2 9 DIGIT PARCEL ID NUMBER 1,1 CZV Cj CI
Legal Description:
Subdivision Name Block Lot(s) 11.
Section Township 21 North, Range / sE WM
APPLICANT �o be r �' L- St, @ r PHONE 360- /137 - O 9 7
MAILING ADDRESS BOY 14gb
R ,,-- . ‘.\ack•ocJ( (� VIA ZIP 963,3?
PROPERTY OWNER cpber* �• St,-CYN.QI— PHONE 3 .6 ' 4137- 08?7
MAILING ADDRESS .--qbO?( 4g,6
rPor4 �tc.AS1ocl] WA- ZIP ?8 33 7 '/r
CONTRACTOR E War
ar/� PHONE 366 - I/S2- 336 ,
MAILING ADDRESS 25-7 i 51 f t(!/y /0/
�or4- H1J e_`eS ZIP �832_
STATE LICENSE# Ev�.(Z.(1,1 1 4c 088 All-- EXP.DATE 8 / a V
r/
FEDERAL I.D.# 91 - /S1110.70 7
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 n erso C u ty and it's employees,representatives or agents for the purpose of application review and any required later
inspections. Access and right of ent he ap) ;-- rrrrty r tructur s II be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE - 10 i 1 DATE 3 / Z / d'/
y
BASE FEE 41 0. FOR OFFICE USE ONLY RECEIPT# S10 Y
CONSISTENCY REVIEW CASH/CK# sst9a
TOTAL 41, ' DATE S Pig'
/03
*Underground Propane Tank applications require additional information to be submitted. 0 V E R llo. I► 110.
Please contact our office at 360-379-4450 if the back of this application is blank.
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