HomeMy WebLinkAboutBLD203-00500 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#: BLD03-00500 Received Date 8/8/2003
SITE ADDRESS: 146 FIR CIR Issue Date 8/8/2003
PORT HADLOCK, 98339
APPLICANT: RUSSELL D YATES PHONE:
LINDA YATES
146 FIR CIR
PORT HADLOCK WA 983399592 11
SUBDIVISION: BISHOP ACRES Block: Lot:
PARCEL NUMBER: 932300011 Section: 2 Township: 29N Range: 01W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPI983O6 Expires 9/26/2004
OWNER, RUSSELL D YATES PHONE:
if different: LINDA YATES
146 FIR CIR
PORT HADLOCK WA 983399592
PROJECT DESCRIPTION: PROPANE TANK AND HEATING STOVE 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 8/8/2004.
REQUIRED INSPECTIONS:
[11 Tank/Line/Appliance:® �c:—/,3—Z2
FinalApproval: 6 43-03 —
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
1:\F_BLD_Permit_Propane.rpt 10/29/19
BUILDING PERMIT APPLI ION BLRD0 005500
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00500 Received Date: 8/8/2003
SITE ADDRESS: 146 FIR CIR
PORT HADLOCK, 98339
OWNER: RUSSELL D YATES PHONE:
LINDA YATES
146 FIR CIR
PORT HADLOCK WA 983399592
SUBDIVISION: BISHOP ACRES Block: Lot: 11
PARCEL NUMBER: 932300011 Section: 2 Township: 29 N Range: 01 W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPI983O6 Expires 9/26/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION PROPANE TANK AND HEATING STOVE 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
Shoreline _Aquifer Forest: Commercial Rural__
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 PRB 08/08/03 58308
Total: $47.00
JEFFERSON COUNTY COMM,DEVELOPMENT,621 SHERIDAN ST,PORT TOND 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 ADDRESS(911#/Road Name):
/11 b Fir C,I rc (�
po/`L o_it. /0 k C L-1'4 ZIP 3 -5 7
9 DIGIT PARCEL ID NUMBER -[ 3 2 494-'4=2/
Legal Description: /J
Subdivision Name I s (// 4 i Block Lot(s) //
Section Township North, Range WM
APPLICANT VJ 5e I 0 - e.s d- Li vt-SG. /Gc1f5— PHONE - S-S-
/6 Y
MAILING ADDRESS (7 rI r �7/-, r, / p . 1-15— /9 C.-e l L.".A . e. 3�
ZIP
PROPERTY OWNER .sue--^,t.0 PHONE
MAILING ADDRESS
J/ ZIP Q / G
CONTRACTOR /t/pf,c�tTG`I A �/®tD -i1c '(� PHONE 3B 6 S — 6 6 3
MAILING ADDRESS �O S C L V1-1 G --. yl_ D( .
Y a 0._ c_ � tj,/,4 ZIP gS r
STATE LICENSE# V(4,0 CI IS? 953 O I:j 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 a applicant's op or str be reques d and s all occ r curing regularbusiness hours.
APPLICANTS SIGNATUR � �vt�l 2) DATE / / O‘3
FOR OFFICE USE ONLY
BASE FEE RECEIPT#
CONSISTENCY REVIEW CASH/CK#
TOTAL 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.
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AUG - 8 2003 Ri
JEFFERSON COUNTY
DEPT. OF COMMUNITY DEVELOPMENT I