HomeMy WebLinkAboutBLD2003-00427 • •
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 #: BLD03-00427 Received Date 7/11/2003
SITE ADDRESS: 61 MARINER PL Issue Date 7/11/2003
PORT LUDLOW, 98365
APPLICANT: KATHRYN R CARLTON PHONE:
61 MARINER PL
PORT LUDLOW WA 983659765
SUBDIVISION: BAYVIEW VILLAGE DIV 2 Block: Lot:
PARCEL NUMBER: 931900014 Section: 16 Township: 28N Range: 01 E
CONTRACTOR: EVERWARM INC PHONE: (360)582-0231
257151 HWY 101
PORT ANGELES WA 98362
Contractor's License FERRELP055LH Expires 08/01/2004
OWNER, KATHRYN R CARLTON PHONE:
if different: 61 MARINER PL
PORT LUDLOW WA 983659765
PROJECT DESCRIPTION: Above Ground Propane tank& 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 07/11/2004.
REQUIRED INSPECTIONS:
[ ] dr in- •ppliance: /;quK - 6K L/sJE 3O
irammeE efrA 3
1,1 FinalApproval: 6 / . 4.
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
I:\F_BLD_Permit_Propane.rpt 10/29/19c
itUILDING PERMIT APPLICA�N B RD03-00eview ppe 7
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD03-00427 Received Date: 7/11/2003
SITE ADDRESS: 61 MARINER PL
PORT LUDLOW, 98365
OWNER: KATHRYN R CARLTON PHONE:
61 MARINER PL
PORT LUDLOW WA 983659765
SUBDIVISION: BAYVIEW VILLAGE DIV 2 Block: Lot:
PARCEL NUMBER: 931900014 Section: 16 Township: 28 N Range: 01 E
CONTRACTOR: EVERWARM INC PHONE: (360)582-0231
257151 HWY 101
PORT ANGELES WA 98362
Contractor's License FERRELP055LH Expires 08/01/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI Above Ground Propane tank & Fireplace Insert
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:
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 CJZ 07/11/03 58121
Total: $47.00
JEFFERSON COUNTY COMMUNJEVELOPMENT,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* Above Ground PROPANE TANK HEAT STOVE HOT WATER TANK
WOODSTOVE jam 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):
, - �
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9 IGIT PARCEL ID NUMBER -V p7 ,4 /LL,
L-.al Description: '
Su s s ivision Name /���� l/� Block Lot(s)
Section f( Towns ip North, Range / WM
APPLICANT PHONE G��7
MAILING ADDRES' ���'
ZIP
PROPERTY OWNERN"--- PHONE
MAILING ADDRESS
ZIP
CONTRACTOR !�'i% (SaC7/740 4
MAILING ADDRESS L_F/ / o��j /J l ( /v` 2'
Gail T f 9C7 )4/ 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' pro�ert or structure
esshall requu ee an uring regular business hours.
APPLICANTS SIGNATURE G���/ � /� 1�/��� DATE 7:7 / / cAjF
-7otrOR OFFICE USE ONLY
BASE FEE I I RECEIPT# 6 0<
CONSISTENCY REVIEW -"O CASH/CK# f '3 L
TOTAL _1 °d DATE 'i/ !t'? /' o
*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\I NSTALL.DOC
JEFFERSON COUNTY DOD