The URL can be used to link to this page

Home My WebLink AboutBLD2003-00454 BUILDING PERMIT APPLI TION BL v Reviewiew T Ty454 ype: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD03-00454 Received Date: 7/24/2003 SITE ADDRESS: 360 MARINA DR PORT TOWNSEND, 98368 OWNER: CAPE GEORGE COLONY CLUB PHONE: 61 CAPE GEORGE DR PORT TOWNSEND WA 983689403 SUBDIVISION: Block: Lot: PARCEL NUMBER: 002123003 Section: 12 Township: 30 N Range: 02 W CONTRACTOR: FERRELLGAS PHONE: (360)385-6998 2108 SIMS WAY PORT TOWSEND WA 98368 Contractor's License FERRELP055LH Expires 08/01/2004 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION ABOVE GROUND PROPANE TANK AND POOL HEATER 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: `T /D3 � t F&W Landslide if Shoreline Aquifer Forest: Commercial Rural Type Amount Paid By: Date: Receipt: Approved/Date Total: 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 #: BLD03-00454 Received Date 7/24/2003 SITE ADDRESS: 360 MARINA DR Issue Date 7/24/2003 PORT TOWNSEND, 98368 APPLICANT: CAPE GEORGE COLONY CLUB PHONE: 61 CAPE GEORGE DR PORT TOWNSEND WA 983689403 SUBDIVISION: Block: Lot: PARCEL NUMBER: 002123003 Section: 12 Township: 30N Range: 02W CONTRACTOR: FERRELLGAS PHONE: (360)385-6998 2108 SIMS WAY PORT TOWSEND WA 98368 Contractor's License FERRELP055LH Expires 08/01/2004 OWNER, CAPE GEORGE COLONY CLUB PHONE: if different: 61 CAPE GEORGE DR PORT TOWNSEND WA 983689403 PROJECT DESCRIPTION: ABOVE GROUND PROPANE TANK, HOT WATER TANK AND POOL HEATER 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 07/24/2004. REQUIRED INSPECTIONS: [ ] Tank/Line/Appliance: [ ] FinalAppro 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 10/29/19 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 t� HOT WATER TANK WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE y OTHER(Please Specify)T 4 i t y' 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): 360 AA A"Vt:r t-) A ) &. GA-FE- 6,f C -`"iLl 'f'+..}1„7 w.11- ZIP CI- c e 3 �.i 9 DIGIT PARCEL ID NUMBER Q 0 2_( 2- 3 19Zo ' Legal Description: Subdivision Name Block Lot(s) Section Township North, Range WM APPLICANT -(0l.A.tJ9'IC-9..) 1, fj o cp 67-e_S PHONE 3 ::.(3 '--3 O 1- ? s MAILING ADDRESS Z)0 C--(-- L C312 12-!'I* S- q `)Cs1L--t- `C O- (�' �1� W "P1- ZIP q L"--.,4 8 PROPERTYOWNER(1A PE 4co G(1._ C.-01.--V(J (1) PHONE 360 3,(K— Eta 3 MAILING ADDRESS Ga ( CJIetE 6r C.1e pc' ( —rc -,t__)s r_tJ CAL/\ ZIP 4G 3‘ CONTRACTOR a /r2e r- t.:- 46S _ _ , _ PHONE MAILING ADDRESS ZIP STATE LICENSE# T g1 R$L_-P O 5-5 L.t EXP.DATE -I 2-`7-0`-- 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 t the appli is property orr�struct ryhall be r uested and shall occur during regular business hours. APPLICANTS SIGNATURE1r+4 La•D.J (e z:� DATE /Z / FOR OFFICE USE ONLY ` V 7q BASE FEE � 1 s RECEIPT# 1 CONSISTENCY REVIEW CASH/CK# lie,9dy TOTAL 't-t1+ t33 DATE y`l t(,Q✓ *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. MIIIM H:\HOME\PLNCNTR\INFOBLDG\FORMS\I NSTALL.DOC s'""