HomeMy WebLinkAboutBLD2003-00417 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 #: BLD03-00417 Received Date 7/7/2003
SITE ADDRESS: 20 NAVIGATOR LN Issue Date 7/7/2003
PORT LUDLOW, 98365
APPLICANT: E MARTIN STUART PHONE:
MARY STUART
20 NAVIGATOR LANE
PORT LUDLOW WA 98365
SUBDIVISION: PORT LUDLOW NO 2 AREA 3 Block: Lot:
PARCEL NUMBER: 990603207 Section: 9 Township: 28N Range: 01E
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2004
OWNER, E MARTIN STUART PHONE:
if different: MARY STUART
20 NAVIGATOR LANE
PORT LUDLOW WA 98365
PROJECT DESCRIPTION:',lbw, ,, 3ti qq \N.0 5 , &to K, -
`"
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 07/07/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: ok ul �ona'�io,15 7/s/0 ,-r
[ [ FinalApproval: ®e for 6/6 y/4/03 I:
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.c
UILDING PERMIT APPLICA N B Review
004 7
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD03-00417 Received Date: 7/7/2003
SITE ADDRESS: 20 NAVIGATOR LN
PORT LUDLOW, 98365
OWNER: E MARTIN STUART PHONE:
MARY STUART
20 NAVIGATOR LANE
PORT LUDLOW WA 98365
SUBDIVISION: PORT LUDLOW NO 2 AREA 3 Block: Lot:
PARCEL NUMBER: 990603207 Section: 9 Township: 28 N 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
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOli
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 By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 CJZ 07/07/03 58107
Total: $47.00
JEFFERSON COUNTY COMMUIDEVELOPMENT,621 SHERIDAN ST,PORT TOWN.WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN/TO THIS INSTALLATION
Underground PROPANE TANK* !t Above Ground PROPANE TANK HEAT STOVE HOT WATER TANK
WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE
F OTHER(Please Specify) 34,10 be 4 � s �j�✓V iQ J
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):
?7dv1'�r� ro(z L .
/ I. Z-14 O7 J GJ/i ZIP /0e365
9 DIGIT PARCEL ID NUMBER % f 0 60 d 3 9-0 7
Legal Description:
Subdivision Name Block Lot(s)
Section y}� Township North, Range WM
APPLICANT 11
/ 1^ I f /� 1�y J1 GI' PHONE �7-
MAILING ADDRESS AO YJ 4 V/1 4 tD-r
L-0 .) (,JL• ZIP
PROPERTY OWNER 62p/A LG-,.7 PHONE
MAILING ADDRESS
ZIP
CONTRACTOR 211-,r-42 PtArr PHONE 3 rs C^ 5 7 f 7
MAILING ADDRESS [ 0 p S3 42,7 O , (•
// . kl�p-O cQ� (./C ZIP 7 (123 y+3 /
t�
STATE LICENSE# St - f 077 Q " EXP.DATE ///tV
FEDERAL I.D.# / O 75 6r•1"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 Je rson 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' )rroopee ty or structure shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE G� ''") - DATE '7 / 2 / 6-3
��// oFOR OFFICE USE ONLY
BASE FEE �� RECEIPT# G 2
CONSISTENCY REVIEW �� CASH/CK# - 6 3 1 7
TOTAL ' 71 O v DATE [ / '7 /c0O3
*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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