HomeMy WebLinkAboutBLD2003-00473 • •
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 #: BLD03-00473 Received Date 7/31/2003
SITE ADDRESS: 190 COLMAN DR Issue Date 7/31/2003
PORT TOWNSEND, 98368
APPLICANT: SUSAN E TANDY PHONE:
190 COLMAN DR
PORT TOWNSEND WA 983689409
30
SUBDIVISION: CAPE GEORGE COLONY DIV 7 Block: 14 Lot:
PARCEL NUMBER: 939601429 Section: 13 Township: 30N Range: 02W
CONTRACTOR: EVERWARM INC PHONE: 800-750-7868
257151 HWY 101
PORT ANGELES WA 98362
Contractor's License EVERWI*088NL Expires 08/17/2004
OWNER, SUSAN E TANDY PHONE:
if different: 190 COLMAN DR
PORT TOWNSEND WA 983689409
PROJECT DESCRIPTION: 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 07/31/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:_
[ ] FinalApproval: 1 Ni j - n" ID?
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 APPLTION BLD03-00473
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD03-00473 Received Date: 7/31/2003
SITE ADDRESS: 190 COLMAN DR
PORT TOWNSEND, 98368
OWNER: SUSAN E TANDY PHONE:
190 COLMAN DR
PORT TOWNSEND WA 983689409
SUBDIVISION: CAPE GEORGE COLONY DIV 7 Block: 14 Lot: 30
PARCEL NUMBER: 939601429 Section: 13 Township: 30 N Range: 02 W
CONTRACTOR: EVERWARM INC PHONE:
257151 HWY 101
PORT ANGELES WA 98362
Contractor's License EVERWI*088NL Expires 08/17/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI 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:
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 ZAN 07/31/03 58190
Total: $47.00
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 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 Manufactured/Mobile Home?
YES >( NO
SITE ADDRESSc�(911#/Road Name):
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9 DIGIT PARCEL ID NUMBER \ 3� ( c `
Legal Description:
Subdivision Name a `K.___, C-k��C\t, c c J -v Block Lot(s)
Section Township North, Range WM
APPLICANT \ PHONE jyy-'j�j \1
MAILING ADDRESS \O C.o4 AG-.Yti
ZIP c(--) � C�
PROPERTY OWNER PHONE
MAILING ADDRESS
ZIP �
CONTRACTOR _�}Q C�C�( 1�1 PHONE \ -`v O v -. Co O (OS
MAILING ADDRESS `--5 \` \ \ vJ\J\ \ Q \ eaN--\ .n
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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 property or structure shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE DATE l / I / y�
100 FOR OFFICE USE ONLY �/
BASE FEE r RECEIPT# 5-0-( 1
CONSISTENCY REVIEW //__�� CASH/CK# ( �
--7
TOTAL 11 DATE ( 3 (
*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. 1111=k
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