HomeMy WebLinkAboutBLD2003-00439 • !
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#: BLD03-00439 Received Date 7/17/2003
SITE ADDRESS: 161 S PALMER DR Issue Date 7/17/2003
PORT TOWNSEND, 98368
APPLICANT: DWAYNE A BLONDIN PHONE:
DIANE J BLONDIN
161 S PALMER DR
PORT TOWNSEND WA 983689436 2
SUBDIVISION: CAPE GEORGE COLONY DIV 4 Block: 11 Lot:
PARCEL NUMBER: 938701102 Section: 12 Township: 30N Range: 02W
CONTRACTOR: FERRELLGAS PHONE: (360)582-0231
646 SO 3RD AVE
SEQUIM WA 98382
Contractor's License FERRELP055LH Expires 08/01/2004
OWNER, DWAYNE A BLONDIN PHONE:
if different: DIANE J BLONDIN
161 S PALMER DR
PORT TOWNSEND WA 983689436
PROJECT DESCRIPTION: ABOVE GROUND PROPANE TANK AND 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 07/17/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line Appliance: IrrnoJ . 'C"v vJt� b cx "Yb c.fi-) o�y 7/7 ZJ )
[ ] FinalApproval:T J Ltnit t3o,VTasir� 74-2Jo1
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
9:\F_BLD_Perm it_Propane.rpt 10/29/19C
BUILDING PERMIT APPLI•TION BL Review T Ty y439
pe:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD03-00439 Received Date: 7/17/2003
SITE ADDRESS: 161 S PALMER DR
PORT TOWNSEND, 98368
OWNER: DWAYNE A BLONDIN PHONE:
DIANE J BLONDIN
161 S PALMER DR
PORT TOWNSEND WA 983689436
SUBDIVISION: CAPE GEORGE COLONY DIV 4 Block: 11 Lot: 2
PARCEL NUMBER: 938701102 Section: 12 Township: 30 N Range: 02 W
CONTRACTOR: FERRELLGAS PHONE: (360)582-0231
646 SO 3RD AVE
SEQUIM WA 98382
Contractor's License FERRELP055LH Expires 08/01/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr ABOVE GROUND PROPANE TANK AND 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:
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
F&W Landslide
Routing Date: /r) 43 Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Total:
JEFFERSON COUNTY COMITY DEVELOPMENT,621 SHERIDAN ST,PORT TV/SEND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN
�T�O' THIS INSTALLATIONj� o e� h9 FCP o m
Underground PROPANE TANK* ,A Above Grdund PROPANE TANK HEAT STOVE HOT WATER TANK
WOODSTOVE X. 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):
/6! sn -'tzl me—e .l� to
9 DIGIT PARCEL ID NUMBER 9..5 f 2__
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT DUJ.t2 nP LJ o n i Y> (T 1 OM. PHONE 360 —3`l 1— O 7 .3 C.
MAILING ADDRESS Ho I So I ca rive. q a
pvyT h./►'use v c) L ZIP I"O.r34
PROPERTY OWNER 7 -rvv8 - PHONE
MAILING ADDRESS (2 rn,
ZIP 9 13 3 $Z.,,
CONTRACTOR F-- R,,e4_1Q.(,,,6A a PHONE 340 6$3- 90
MAILING ADDRESS Lf.Z 5". 3e.1 fl V L
Se q t4a f h/ G�� 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 ent the applicant's property or structure shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE DATE / / C)rI / O
j 0 O FOR OFFICE USE ONLY
BASE FEE y RECEIPT#
CONSISTENCY REVIEW CASH/CK#
TOTAL L17 6 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. IMINk
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