HomeMy WebLinkAboutBLD2003-00502 I
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 #: BLD03-00502 Received Date 8/8/2003
SITE ADDRESS: 220 VICTORIA LOOP Issue Date 8/8/2003
PORT TOWNSEND, 98368
APPLICANT: ALFRED N EVANS TRUSTEE PHONE:
LISE EVANS TRUSTEE
220 VICTORIA LOOP
PORT TOWNSEND WA 983689473 17
SUBDIVISION: CAPE GEORGE COLONY DIV 1 Block: 2 Lot:
PARCEL NUMBER: 937800217 Section: 12 Township: 30N Range: 02W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2004
OWNER, ALFRED N EVANS TRUSTEE PHONE:
if different: LISE EVANS TRUSTEE
220 VICTORIA LOOP
PORT TOWNSEND WA 983689473
PROJECT DESCRIPTION: NO MLA REQ'D - PROPANE GAS PIPE,ABOVE GROUND PROPANE
TANK, HEAT 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:
[ pp i41JK ���T ti-trJ ®� C I%-2L�
Tank/Line/A Hance: ;
[yff/ FinalApproval: C- 91- o -�
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 APPLICATION BLDO3-005502
view Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00502 Received Date: 8/8/2003
SITE ADDRESS: 220 VICTORIA LOOP
PORT TOWNSEND, 98368
OWNER: ALFRED N EVANS TRUSTEE PHONE:
LISE EVANS TRUSTEE
220 VICTORIA LOOP
PORT TOWNSEND WA 983689473
SUBDIVISION: CAPE GEORGE COLONY DIV 1 Block: 2 Lot: 17
PARCEL NUMBER: 937800217 Section: 12 Township: 30 N Range: 02 W
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 DESCRIPTIOr NO MLA REQ'D - PROPANE GAS PIPE, ABOVE GROUND PROPANE
TANK, HEAT 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
fifn 3 Shoreline Aquifer
6 Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $47.00 MJA 08/08/03 58366
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* y Above Ground PROPANE TANK J` HEAT STOVE HOT WATER TANK
WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE
r OTHER(Please Specify) ] P"r-L
Is this appliance (htg stove, hot water tank,furnace, etc.) to be installed in a Manufactured/Mobile Home?
YES ,k NO
SITE ADDRESS(911#/Road Name):
0 0-0 (J 1 C1 rt o•- Lacy,
P 1 - To(.tJY.-cs € r'13 ZIP 7 U . G a'
9 DIGIT PARCEL ID NUMBER q 3 7 goo 2 /7
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT L1.5 E-041.''.S PHONE 3 U .S - 1// 1---
MAILING ADDRESS k.a (- --
ZIP
PROPERTY OWNERe-41-74_ PHONE
MAILING ADDRESS 4!✓`'t—
ZIP
CONTRACTOR '
e SUNSHINE PROPANE EMAILING ADDRESS to Quality Energy Services Since 1980
10853 Rhody Dr.Hadlock,WA 98339
Ili '� l (360)385-5797 or 683-4010
www.sunshinepropane.com
STATE LICENSE# 7 .PIT. ///0
FEDERAL I.D.# ci—( 075 �J
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 perty or structure shall be requested and shall occur during regular business hours. cL
APPLICANTS SIGNATURE (((4 114-1)�— Cfr/'—fir (e U}T4) DATE e / ( /
���/// �J))FOR OFFICE USE ONLY
BASE FEE ��. RECEIPT# -3
CONSISTENCY REVIEW CASH/CK#
/I
`7 7 , 00 n �
TOTAL DATE /0/D3
*Underground Propane Tank applications require additional information to be submitted. f No '' R
Please contact our office at 360-379-4450 if the back of this application is blank._:, '_..i t VI . 1
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