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HomeMy WebLinkAboutBLD2003-00360 • • 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 #: BLD03-00360 Received Date 6/11/2003 SITE ADDRESS: 657 CRUTCHER RD Issue Date 6/11/2003 PORT TOWNSEND, 98368 APPLICANT: BETH R LORBER BONYUN PHONE: PO BOX 1024 PORT TOWNSEND WA 983680010 T 13 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001184014 Section: 18 Township: 30N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2004 OWNER, BETH R LORBER BONYUN PHONE: if different: PO BOX 1024 PORT TOWNSEND WA 983680010 PROJECT DESCRIPTION: Propane Tank Above Ground 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 06/11/2004. REQUIRED INSPECTIONS: [ ] Tank/Line/Appliance: [ ] FinalApproval: 7 112. 2 ,RV—Oj 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_PLD_Perm it_Propane.rpt 10/29/19 BLD03-00360 .UILDING PERMIT APPLICA.ON Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD03-00360 Received Date: 6/11/2003 SITE ADDRESS: 657 CRUTCHER RD PORT TOWNSEND, 98368 OWNER: BETH R LORBER BONYUN PHONE: PO BOX 1024 PORT TOWNSEND WA 983680010 SUBDIVISION: Block: Lot: T 13 PARCEL NUMBER: 001184014 Section: 18 Township: 30 N Range: 01 W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2004 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION Propane Tank Above Ground TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 1997 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: 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 Bv: Date: Receipt: Approved/Date `ropane Tanks/Stoves $47.00 CJZ 06/11/03 56385 Total: $47.00 JEFFERSON COUNTY COMMUEVELOPMENT,621 SHERIDAN ST,PORT TOWN WA 98368 PH: (360)379-4450 LLATION PERMIT APPLICATION MARK ALL ITEMS BELOW THAT PERTAINTOINSTTHIS INSTALLATION Underground PROPANE TANK* X 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): 657 Lrr .. c t7 , P©�-L *To cio.3 i CC i c�A p /, ZIP 9 O �,g 9 DIGIT PARCEL ID NUMBER e)0 1, 1 0 4' © (4. Legal Description: -yam 0 SS TO Ic? otA -b(' �E�s-i�j Subdivision Name l 30 Q (. lam) -A X t Block Lot(s) w Section Township North, Range WM APPLICANT t'rji Fe__ D.ivyo N PHONE jo J 7 p CEO MAILING ADDRESS Po &x (02-c-- �I , P027 - )coNs (U D t Pr ZIP (cg PROPERTY OWNER {31��-(4 . Lo Q2e—anklYO ly, PHONE opt c MAILING ADDRESS E- ZIP CONTRACTOR Su S�� �I QJ E P0_0(3.Q.1� PHONE —, 5? :7 MAILING ADDRESS ( "0&c (214e)f t2- /gyp f 2 7 �+ -te, ZIP `'G D 3/31 / STATE LICENSE# SC) U 1 1 p 77 0( r EXP.DATE 1 t / 17 O 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 a:d right of: try t. • - ,n County and it's employees,representatives or agents for the purpose of application review and any required later inspections. Access and right of- try t•thh' r pli nt's prof- or structure shall be requested and shall occur during regular business hours. APPLICANTS SIGNATURE lr✓/ iI DATE 6, / 11 / i/7.0� OR OFFICE USE ONLY RECEIPT# 1p3tS BASE FEE `yyf�� CONSISTENCY REVIEW CASH/CK# 12 I TOTAL 47 lU t 00 DATE (p / it 103 *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, ..- H:\HOME\PLNCNTR\INFOBLDG\FORMS\INSTALL.DOC JUN 11i JEFFERSON COUNTY®CD