HomeMy WebLinkAboutBLD2003-00387 • •
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 #: BLD03-00387 Received Date 6/23/2003
SITE ADDRESS: 394 MERRY RD Issue Date 6/23/2003
NORDLAND, 98358
APPLICANT: JAMES E GRAF PHONE:
394 MERRY RD
NORDLAND WA 983589627
14
SUBDIVISION: OLSON & HAMBLETON'S Block: Lot:
PARCEL NUMBER: 977700040 Section: 9 Township: 29N Range: 01 E
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2004
OWNER, JAMES E GRAF PHONE:
if different: 394 MERRY RD
NORDLAND WA 983589627
PROJECT DESCRIPTION: ABOVE GROUND PROPANE TANK
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 06/23/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: 4051
[ ] FinalApproval: f ii/r 0// r1
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
�:\F_BLD_Permit_Propane.rpt 10/29/19.c
BUILDING PERMIT APPL ATION B RDO3NOOp387
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00387 Received Date: 6/23/2003
SITE ADDRESS: 394 MERRY RD
NORDLAND, 98358
OWNER: JAMES E GRAF PHONE:
394 MERRY RD
NORDLAND WA 983589627
SUBDIVISION: OLSON & HAMBLETON'S Block: Lot: 14
PARCEL NUMBER: 977700040 Section: 9 Township: 29 N Range: 01 E
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractors License SUNSHP*077QP Expires 11/17/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr ABOVE GROUND PROPANE TANK
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: 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
Propane Tanks/Stoves $47.00 ZAN 06/23/03 57933
Total: $47.00
Air
JEFFERSON COUNTY COM ITY DEVELOPMENT,621 SHERIDAN ST,PORT T JSEND 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):
4 .
,,,,' d / IN t1 ZIP CDLSS
9 DIGIT PARCEL ID NUMBER ! 7 7 / U U v 7 D
Legal Description:
Subdivision Name Block Lot(s)
Section ��/ Township North, Range WM
APPLICANT ^ l7 �/ 3
`-' 6- // �J PHONE 6
MAILING ADDRESS /1� O '/ t�`1' `�/ Ill ,
X)!n^1 -.-._a / ti� :..Ja_ ZIP ff/��PROPERTY OWNER Lvec GPHONE
MAILING ADDRESS
ZIP
CONTRACTOR L D0.7�-,--,_e PHONE ,3ap
J 5-7 2.7
MAILING ADDRESS /O?S i
P% ZIP 7(Yyjf
STATE LICENSE# ,,f-I d 77 Q f EXP.DATE ///O y
FEDERAL I.D.# //—/0 7 (KS. 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 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.
APPLICANT'S SIGNATURE r— "`- '----"-' - DATE 6 / /,'/ 0
LI FOR OFFICE USE ONLY —7
BASE FEE RECEIPT##(JJ 2 `S / q 3 3
CONSISTENCY REVIEW � /3 u CASH/CK# O-
TOTAL 4-1 .07 DATE lc, pc:23 N3
*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.
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JUH 2 3 2003