HomeMy WebLinkAboutBLD2003-00359 • •
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#: BLD03-00359 Received Date 6/6/2003
SITE ADDRESS: 190 MOA HILL RD Issue Date 6/11/2003
PORT TOWNSEND, 98368
APPLICANT: DONNA J CAULTON PHONE:
190 MOA HILL RD
PORT TOWNSEND WA 983689772
T 56
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 902243023 Section: 24 Township: 29N Range: 02W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2004
OWNER, DONNA J CAULTON PHONE:
if different: 190 MOA HILL RD
PORT TOWNSEND WA 983689772
PROJECT DESCRIPTION: GAS PIPE, FIREPLACE, DEMAND WATER HEATER INSTALLATION
- NO MLA REQ'D
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 6/11/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: ASK -f f/PPL/,4'/)!'E .:.24, ezAs-
/4
.,_
4.)-reiez .61)e---s- OK (7 ...p,_ 6- As effet-44, 0- 4—,"
[ ] FinalApproval: OK 4 r -fire's(.?. I 3/i/'cs '
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 APPLICN BLD03-00359
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00359 Received Date: 6/6/2003
SITE ADDRESS: 190 MOA HILL RD
PORT TOWNSEND, 98368
OWNER: DONNA J CAUL TON PHONE:
190 MOA HILL RD
PORT TOWNSEND WA 983689772
SUBDIVISION: Block: Lot: T 56
PARCEL NUMBER: 902243023 Section: 24 Township: 29 N Range: 02 W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*0770P Expires 11/17/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION GAS PIPE, FIREPLACE, DEMAND WATER HEATER INSTALLATION -
NO MLA REQ'D
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
Permit $47.00 MJA 06/06/03 56349
Total: $47.00
JEFFERSON COUNTY COMMUfyDEVELOPMENT,621 SHERIDAN ST,PORT TOW< D WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
/o1-o
Underground PROPANE TANK* Above Ground PROPA E TANK HEAT STOVE HOT WATER TANK
WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE
OTHER(Please Specify) 1j 4. n/r urn
—` /-6�� z, /7(
Is this appliance (htg stove,//_ hot water tank, ace,etc.)tO be installed in a Manufactured/Mobile Home?
YES NO
SITE ADDRESS(911 #/Road Name): 1 9 6
/ yr/o& y4
>6 %®(--)) Ka ''jj r ZIP
9 DIGIT PARCEL ID NUMBER 9 s)-_ 4 4-0 0 0- 3
Legal Description:
Subdivision Name Block Lots)
Section Township North, Range WM
APPLICANT `6OMP1- '---4-- d PHONE
MAILING ADDRESS 6
ZIP
PROPERTY OWNER T'c-c c,,..7" PHONE
MAILING ADDRESS
ZIP
CONTRACTOR e"...,..v414.,„2
L 9 P(((N�2�_ PHONE 2(Kr�7[ 7
MAILING ADDRESS /0t s ,3 4 c. 1
, .. )(/o ,�-4 �G.� ZIP 10pJ -
STATE LICENSE# cliLn..r/L. - 077 OP EXP.DATE ///a Y
FEDERAL I.D.# 9(` 70 75 crS-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 of entry to Jefferson Co my 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 r structure shall be requeste and shall occur during regular business hours.
APPLICANTS SIGNATURE �� 1�0,- - 4,e) DATE 6 1 3 l Vj
`'C 0-3 FOROFFICE USE ONLY �/ 7
BASE FEE �� RECEIPT# rb
CONSISTENCY REVIEW CASH/CK# 9(2 r72
3
('�TOTAL 1' () DATE & / & /�/J
*Underground Propane Tank applications require additional information to be submitted. OVER
Please contact our office at 360-379-4450 if the back of this application is blank. IIIMM
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