HomeMy WebLinkAboutBLD2003-00390 ! 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 #: BLD03-00390 Received Date 6/24/2003
SITE ADDRESS: 100 S RHODODENDRON DR Issue Date 6/24/2003
PORT TOWNSEND, 98368
APPLICANT: LINCOLN TRUST COMPANY PHONE:
CUSTODIAN/GLEN SVENDSEN
100 S RHODODENDRON DR
PORT TOWNSEND WA 983689437 33
SUBDIVISION: CAPE GEORGE COLONY DIV 3 Block: 5 Lot:
PARCEL NUMBER: 938400532 Section: 12 Township: 30N Range: 02W
CONTRACTOR: OWNER/BUILDER PHONE:
OWNER, LINCOLN TRUST COMPANY PHONE:
if different: CUSTODIAN/GLEN SVENDSEN
100 S RHODODENDRON DR
PORT TOWNSEND WA 983689437
PROJECT DESCRIPTION: REPLACE CHIMNEY ON 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 06/24/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: p/fo& CLE,4x47,.,�,: / ti5 44,4E d„� a .5---.77-03
[4,1 FinalApproval:it,If,— G 30-01
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 10/29/19c
03
• BUILDING PERMIT APPL .�►TION BL ReviewTy390
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00390 Received Date: 6/24/2003
SITE ADDRESS: 100 S RHODODENDRON DR
PORT TOWNSEND, 98368
OWNER: LINCOLN TRUST COMPANY PHONE:
CUSTODIAN/GLEN SVENDSEN
100 S RHODODENDRON DR
PORT TOWNSEND WA 983689437
SUBDIVISION: CAPE GEORGE COLONY DIV 3 Block: 5 Lot: 33
PARCEL NUMBER: 938400532 Section: 12 Township: 30 N Range: 02 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION REPLACE CHIMNEY ON WOODSTOVE
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION
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
Propane Tanks/Stoves $47.00 ZAN 06/24/03 57934
Total: $47.00
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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 I;61Rci.aET PELLET STOVE COOKING STOVE
OTHER(Please Specify) (��� -�� G �
Is this appliance (htg stove, hot water tank,furnace, etc.) to be installed in a Manufactured/Mobile Hom`e�'
YES - NO
SITE ADDRESS(911#/Road Name):
.-C,' it,rtaGe /49-eav-1 c61
�(y-t (:C '77� P- �C►e S- f- (i(J A ZIP / ` 25
`1
9 DIGIT PARCEL ID NUMBER ' --is- 4:f:,0 ,j 3 z
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
l \
APPLICANT G eK _S ve�60�--(/ - PHONE J /� �7 1/2,4 (7 c/ C��'�\
MAILING ADDRESS CX0 Z Cj`.La. 2,(,2� nn p� Li < 7j- � -796 (e f )
�vC,. , 1/ 9-`7Y 2/ ZIP /
PROPERTY OWNER / PHONE
MAILING ADDRESS 5 A��
y ZIP
JL CONTRACTOR l/A PHONE
MAILING ADDRESS /
ZIP
STATE LICENSE# 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 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. �/
APPLICANTS SIGNATURE �e--'." -_ DATE / �C /0-
FOR OFFICE USE ONLY
BASE FEE RECEIPT#
CONSISTENCY REVIEW CASH/CK#
TOTAL DATE / /
*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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