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HomeMy WebLinkAboutBLD2003-00388 0 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 #: BLD03-00388 Received Date 6/24/2003 SITE ADDRESS: 384 BEE MILL RD Issue Date 6/24/2003 BRINNON, 98320 APPLICANT: MR & MRS R LOUGHEED PHONE: (360)236-0111 859 PEAR CT NE OLYMPIA WA 98506-1239 T4 SUBDIVISION: Block: Lot: PARCEL NUMBER: 602133022 Section: 13 Township: 26N Range: 02W CONTRACTOR: QUALITY APPLIANCE PHONE: (360)427-1202 2505 OLYMPIC HWY N#220 SHELTON WA 98584 Contractor's License QUALIA*98400 Expires 9/20/2004 OWNER, MR & MRS R LOUGHEED PHONE: (360)236-0111 if different: 859 PEAR CT NE OLYMPIA WA 98506-1239 PROJECT DESCRIPTION: ABOVE GROUND TANK WITH FIREPLACE INSERT 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 6/24/2004. REQUIRED INSPECTIONS: [i,r Tank/Line/Appliance: 0/` r ,<---7 Ol [ '3J FinalApproval: 01<- !/ a1 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 a:\F_BLD_Permit_Propane.rpt 10/29/19 BLD03-00388 1143UILDING PERMIT APPLICAON Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD03-00388 Received Date: 6/24/2003 SITE ADDRESS: 384 BEE MILL RD BRINNON, 98320 OWNER: MR & MRS R LOUGHEED PHONE: (360)236-0111 859 PEAR CT NE OLYMPIA WA 98506-1239 SUBDIVISION: Block: Lot: T 4 PARCEL NUMBER: 602133022 Section: 13 Township: 26 N Range: 02 W CONTRACTOR: QUALITY APPLIANCE PHONE: (360)427-1202 2505 OLYMPIC HWY N#220 SHELTON WA 98584 Contractor's License QUALIA*98400 Expires 9/20/2004 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION ABOVE GROUND TANK WITH FIREPLACE INSERT 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 Bv: Date: Receipt: Approved/Date Permit $47.00 MJA 06/24/03 56428 Total: $47.00 JEFFERSON COUNTY COMMUNEVELOPMENT,621 SHERIDAN ST,PORT TOWN,D WA 98368 PH: (360)379-4450 INSTALLATION PERMIT APPLICATION MARK ALL ITEMS BELOW THAT PERTAIN TO TH INSTALLATION �4.v6- Sed' III.' GL.a'&tL 1 — Underground PROPANE T NK* �ove Ground PROPANE TANK HEAT STOVE HOT WATER TANK WOODSTOVE V FIRE��INERT 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 s NO SITE ADDRESS(911#/Road Name): n 136 I (2, (L 1 1d lU o N (.,lv Pt— ZIP irc.3eg0 9 DIGIT PARCEL ID NUMBER c-P 0 /,3 50 o-.. Legal Description: Subdivision Name Block Lot(s) Section / .3 Township 2, ' /1 North, Range oL w 67,s--7-' WM APPLICANT A-1.-F"t4- i- L © U. 4 d----� PHONE 6,C 9,9)6, 0( I ( MAILING ADDRESS V 0 P�4--(2-- Q.i fl.5 C) L-YYYI4 ( A--- lik") f ZIP 9'56 6 / / PROPERTY OWNER ,� �p PHONE 6 a P,c�CU (S) ( ( ( MAILING ADDRESS C -- CIA) ( ,13 g - ,/� ZIP CONTRACTOR cyds1-&-/71J � PPiia�c� %.e- PHONE MAILING ADDRESS 2OS o(A I£A1 4e.- 46.-it'( JJ I II°, a u� cS 'ice ltoOr- 7�6 a7' ZIP �I,6 T STATE LICENSE# OfIA-L'444 7 .e/w 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 ail liabilities,judgments,court costs,reasonable attorneys 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 r ht of entry to Jefferson���unty it's employees,representatives or agents for the purpose of ap tion review and any required later inspections. Access and right of entt the applicAnt's proper str t e shall be requested d shall occur during regular business h r;. APPLICANTS SIGNATURE i •.- L DATE '/I ,f9Cli OC_)t)-..3 17 �0 FOR OFF CE USE ONLY ( � — L BASE FEE t1 , r �(�0�2 RECEIPT# tiJ , CONSISTENCY REVIEW �� PN\ CASH/CK# 7 Z 2_ ? - TOTAL t l 1 9 ' t^'U` DATE _/2'/l C 3 *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. ..k...- .11.1* H:\HOME\PLNCNTR\INFOBLDG\FORMS\INSTALL.DOC 12, \w g