HomeMy WebLinkAboutBLD2003-00501 BUILDING PERMIT APPLI Review T Ty TION BL y501
pe:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00501 Received Date: 8/6/2003
SITE ADDRESS: 61 HARMS LN
PORT LUDLOW, 98365
OWNER: ROBERT A MOSS PHONE:
ELIZABETH W MOSS
61 HARMS LN
PORT LUDLOW WA 98365-9610
SUBDIVISION: PORT LUDLOW NO 2 AREA 3 Block: Lot: 198
PARCEL NUMBER: 990603198 Section: 9 Township: 28 N Range: 01 E
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP NO MLA REQ'D - PROPANE GAS RANGE, ABOVE GROUND 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:
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: 3)-ec-- F&W Landslide
Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $47.00 MJA 08/06/03 58365
Total: $47.00
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 #: BLD03-00501 Received Date 8/6/2003
SITE ADDRESS: 61 HARMS LN Issue Date 8/8/2003
PORT LUDLOW, 98365
APPLICANT: ROBERT A MOSS PHONE:
ELIZABETH W MOSS
61 HARMS LN
PORT LUDLOW WA 98365-9610 198
SUBDIVISION: PORT LUDLOW NO 2 AREA 3 Block: Lot:
PARCEL NUMBER: 990603198 Section: 9 Township: 28N Range: 01 E
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2004
OWNER, ROBERT A MOSS PHONE:
if different: ELIZABETH W MOSS
61 HARMS LN
PORT LUDLOW WA 98365-9610
PROJECT DESCRIPTION: NO MLA REQ'D -PROPANE GAS RANGE,ABOVE GROUND 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 8/8/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: " /7tho OK 1743 AOPAI.)E `.hoe- �K 8/4'/13
[ ] FinalApproval: o 10 .
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 COM•TY DEVELOPMENT,621 SHERIDAN ST,PORT TEND 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
//O":THER(Please Specify) icA4
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):
G ( 6-7- .L,J
/-%- h 14-70 1-Ct G44-- ZIP ! Ce36
9 DIGIT PARCEL ID NUMBER 9 ! 0 (O o
Legal Description:
Subdivision Name Block Lot(s)
Section W
,/ ' Township North, Range M
APPLICANT Rt7 i0 ' -- 0 PHONE
MAILING ADDRESS
ZIP
PROPERTY OWNER � c-c f'► PHONE
MAILING ADDRESS
ZIP
CONTRACTOR SUNSHINE PROPANE PHONE
MAILING ADDRESS �� Quality Energy Services Since 1980
10853 Rhody Dr. Hadlock,WA 98339
'� (360)385-5797 or 683-4010 ZIP
www.sunshinepropane.com
•
STATE LICENSE# EXP.DATE ///"d/
FEDERAL I.D.# 9 p/ 0 7 ! O S7
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 Cou and it's employees, representatives or agents for the purpose of application review and any
required later inspections. Access and right of en ry to the applicant property or structure shall be requested and shall occur during regulareg business hours.
APPLICANT'S SIGNATURE G � DATE (f / 6 / 0_1
0,, FOR OFFICE USE ONLY
BASE FEE RECEIPT#
CONSISTENCY REVIEW CASH/CK#
fl O 03
TOTAL ''` , ° DATE / �/
*Underground Propane Tank applications require additional information to be submitted. Q V
t t:en iJ f:�
Please contact our office at 360-379-4450 if the back of this application is bla .�J�r• -- .
- i_ t... l
H:HOME\PLNCNTR\INFOBLDG\FORMS\INSTALL.DOC 11111*
i
N AUG - 8 2003
.30N 'COUNTY