HomeMy WebLinkAboutBLD2003-00461 1111 •
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 #: BLD03-00461 Received Date 7/28/2003
SITE ADDRESS: 83 TERRACE DR Issue Date 7/28/2003
PORT TOWNSEND, 98368
APPLICANT: CLAUDE B GRAVES JR PHONE:
JUDY S GRAVES
130 FAIRBREEZE DR
PORT TOWNSEND WA 983689582 15
SUBDIVISION: KALA TERRACE Block: Lot:
PARCEL NUMBER: 965900015 Section: 26 Township: 30N Range: 01W
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 9/6/2004
OWNER, CLAUDE B GRAVES JR PHONE:
if different: JUDY S GRAVES
130 FAIRBREEZE DR
PORT TOWNSEND WA 983689582
PROJECT DESCRIPTION: Propane tank installation
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 7/28/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: —71300- O/c 7 24+;//1
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[Yl FinalApproval:
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
%BUILDING PERMIT APPLICSION BLDOe 00461
Reviw Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00461 Received Date: 7/28/2003
SITE ADDRESS: 83 TERRACE DR
PORT TOWNSEND, 98368
OWNER: CLAUDE B GRAVES JR PHONE:
JUDY S GRAVES
130 FAIRBREEZE DR
PORT TOWNSEND WA 983689582
SUBDIVISION: KALA TERRACE Block: Lot: 15
PARCEL NUMBER: 965900015 Section: 26 Township: 30 N Range: 01 W
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 9/6/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION Propane tank installation
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
Routing Date: F&W Landslide
tfp Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 PRB 07/28/03 58087
Total: $47.00
JEFFERSON COUNTY COMM•DEVELOPMENT,621 SHERIDAN ST,PORT TOD WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TOI THIS INSTALLATION
Underground PROPANE TANK* >c Above Ground PROPANE TANK HEAT STOVE HOT WATER TANK
WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE
OTHER(Please Specify)
Is this appliance (htg stove, hot water tank,furnace, etc.)to be installed in a Manu 7rer M .T
SITE ADDRESS(911#/Road Name):
g 3 k/ ce Lz. 2 iJ`' Jet 2 $ MO L
Pc �j %r�Isaws „).0 1,0 ii' ZIP 'CW3 LP L
) JEFFERSON COUNTY
9 DIGIT PARCEL ID NUMBER c 5' 'ZOD ( COMMUNITY DEVELOPME
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT C CA VOt \ GRA I7LE-S u fC , PHONE 3 t O , 3-7 --...3 Z,,
MAILING ADDRESS R- 1-- fA'sv4...14C,f=~ 1DA ,
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PROPERTY OWNER C1_19 t.({)&:- f? _ '3 fir f 1L� t)—✓' PHONE -3 kO --3`"? / -3 Q-3Z,
MAILING ADDRESS e_3 - .1)fQ , l
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Pm' ,l 4��S �7 u�/ ZIP 9 a 3'c
CONTRACTOR C E./0 tr PHON
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 roperty or structure shall be req ested and shall occur during regular business hours.
APPLICANTS SIGNATURE %A, Ge5u 7 DATE C--) / 2 /
fit?`�CFOR OFFICE USE ONLY '�O
BASE FEE T RECEIPT#CONSISTENCY REVIEW //�� 0 CASH/CK# / 0 5—S�
TOTAL 410d0 DATE 7_/f4 /
*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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