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Home My WebLink AboutBLD2003-00503 • • • • 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 #: BLD03-00503 Received Date 8/8/2003 SITE ADDRESS: 140 C ST Issue Date 8/11/2003 PORT HADLOCK, 98339 APPLICANT: LEONARD ROBBINS PHONE: (360) 379-0342 CLARICE ROBBINS PO BOX 433 CHIMACUM WA 98325-0433 7-8 SUBDIVISION: SOUTH PORT TOWNSEND Block: 11 Lot: PARCEL NUMBER: 996401107 Section: 2 Township: 29N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2004 OWNER, LEONARD ROBBINS PHONE: (360) 379-0342 if different: CLARICE ROBBINS PO BOX 433 CHIMACUM WA 98325-0433 PROJECT DESCRIPTION: NO MLA REQ'D -PROPANE TANK, GAS HEAT STOVE & GAS PIPE 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 8/11/2004. REQUIRED INSPECTIONS: [ 7 Tank/Line/Appliance: �`- 7'0, [ ' FinalApproval: (A)7 COS g v2 7"C� 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_Perm it_Propa ne.rpt 10/29/19 BLD03-00503 . _ • BUILDING PERMIT APPLI LION Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD03-00503 Received Date: 8/8/2003 SITE ADDRESS: 140 C ST PORT HADLOCK, 98339 OWNER: LEONARD ROBBINS PHONE: (360) 379-0342 CLARICE ROBBINS PO BOX 433 CHIMACUM WA 98325-0433 SUBDIVISION: SOUTH PORT TOWNSEND Block: 11 Lot: 7-8 PARCEL NUMBER: 996401107 Section: 2 Township: 29 N Range: 01 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 TANK, GAS HEAT STOVE & GAS PIPE INSTALLATION TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 1976 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: 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 ' ( 0 3 1 , Shoreline Aquifer / Forest: Commercial Rural Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $47.00 MJA 08/08/03 58366 Total: $47.00 JEFFERSON COUNTY COM•TY 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 `/ / r Underground PROPANE TANK* 7�� Above Ground PROPANE TANK y H ITsSSTOVE HOT WATER TANK WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE yOTHER(Please Specify) 0(/)UJ 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): (1{0 C , Pi N 4-s-,c,o ZIP .C13 f 9 DIGIT PARCEL ID NUMBER '1 9 V0 1/-0 ( /O Legal Description: Subdivision Name Block Lot(s) Section Township North, Range WM r APPLICANT L.e, r c/�'r-i POLt. / h 1 PHONE 3 7 g O J '�— MAILING ADDRESS 1 ,O 4 IS-3 Z-- PfTZ itvcoC ,, ZIP ��t;►PROPERTY OWNER � / —c-.-.-./- . PHONE MAILING ADDRESS 7/ ZIP CONTRACTOR _ full• 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 if (Os 4STATE LICENSE# EXP.DATE FEDERAL I.D.# 1 - 1 07q cgs 1 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 net of entry to e applicant's property or structureL shall be requested and shall occur during regular business hours. APPLICANT'S SIGNATURE it r` 1,'r w i/CR+. -) DATE / V / o3 BASE FEE 4'�1, FOR OFFICE USE ONLY RECEIPT# S O J v Co CONSISTENCY REVIEW �,f CASH/CK# 9339 TOTAL 41' DATE q / ? / O3 *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. H:\HOME\PLNCNTR\INFOBLDG\FORMS\INSTALL.DOC i