HomeMy WebLinkAboutBLD2003-00483 9 0
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 #: BLD03-00483 Received Date 8/5/2003
SITE ADDRESS: 53 COOK ST Issue Date 8/5/2003
PORT TOWNSEND, 98368
APPLICANT: LOREN C HAMAR PHONE: 360-379-9086
DONNA L HAMAR
53 COOK ST
PORT TOWNSEND WA 983689215
SUBDIVISION: TIBBALS LAKE PARK Block: 35 Lot:
PARCEL NUMBER: 999003506 Section: 4 Township: 30N Range: 01W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTP198306 Expires 09/26/2004
OWNER, LOREN C HAMAR PHONE: 360-379-9086
if different: DONNA L HAMAR
53 COOK ST
PORT TOWNSEND WA 983689215
PROJECT DESCRIPTION: ABOVE GROUND PROPANE TANK AND HEAT STOVE
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 08/05/2004.
REQUIRED INSPECTIONS:
M...., Tank/Line/Appliance: tA✓/Lo oic-c E-(,-03
[t]' FinalApproval: IA/ GOwb e-6-03
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.
• BLD03-00483
BUILDING PERMIT APPLI TION Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00483 Received Date: 8/5/2003
SITE ADDRESS: 53 COOK ST
PORT TOWNSEND, 98368
OWNER: LOREN C HAMAR PHONE: 360-379-9086
DONNA L HAMAR
53 COOK ST
PORT TOWNSEND WA 983689215
SUBDIVISION: TIBBALS LAKE PARK Block: 35 Lot:
PARCEL NUMBER: 999003506 Section: 4 Township: 30 N Range: 01 W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPI983O6 Expires 09/26/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI ABOVE GROUND PROPANE TANK AND HEAT STOVE
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: G F&W Landslide
l5 s D Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $0.00 ZAN 08/05/03
Total: $0.00
JEFFERSON COUNTY COMITY DEVELOPMENT,621 SHERIDAN ST,PORT T•SEND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN''TOTO THIS INSTALLATION
Underground PROPANE TANK* Above Ground PROPANE TANK CHEAT STOVE HOT WATER TANK
WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE
OTHER(Please Specify)
Is this appliance (htg stove, hot water tank,furnace, etc.)to be installed in a Manufactured/Mobile Home?
YES ✓- NO
SITE ADDRESS(911#/Road Name):
5-3 Coo K 5±Pori- Jown5 g peno / I✓, . ZIP 7 S3 6
9 DIGIT PARCEL ID NUMBER 99 -oa3 -So 6
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT 4/Thin 79//1 ?fOf QY) 1° PHONE 3 - 6 4•S 3
MAILING ADDRESS <2. 5 Vi w, )2'Q
Part H4,00,X , I.vt}• ZIP 9$ 3 3 9
PROPERTY OWNER L o r Pn C)?'Q m Q�' PHONE 3 7 9 - ` 04S 6
MAILING ADDRESS 5 3 Coo A s t•
PO r 1 Jn1~.n 5&nod / /. 4. ZIP 9 S 3 6 S
CONTRACTOR 410Nn A` 74 1LN r Pro Q ° PHONE 3 S- 6�i6�3
•
MAILING ADDRESS 65 C',J/019 C h yH F00°,
Pori' Hq Q//O c , t.•t/4 ZIP 98239
/
STATE LICENSE# lY1 a Linn*f L 9 .306 EXP.DATE 9 6 b ti
FEDERAL I.D.# Eva t727 - 9
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 entry to the applicant's property or structure shall be requested and shall occur during regular business hours.
APPLICANT'S SIGNATURE - - DATE
BASE FEE f 1,1l.00 FOR OFFICE USE ONLY RECEIPT#
CONSISTENCY REVIEW CASH/CK# S7
TOTAL ___ DATE / /v�
*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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