HomeMy WebLinkAboutBLD2003-00507 • BUILDING PERMIT APPLIC Revviewiew T TyATION ML y463
pe:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD03-00507 Received Date: 8/12/2003
SITE ADDRESS: 80 BURNS RD
PORT HADLOCK, 98339
OWNER: DAVID W HEID PHONE:
BARBARA L HEID
80 BURNS RD
PORT LUDLOW WA 983659425
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 921194011 Section: 19 Township: 29 N Range: 01 E
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 09/06/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION Underground Propane Tank
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 1997 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 NOk
BEDROOMS: BATHROOMS: STORMWATER: YES NO ---- AREA
Exist: Exist: Wetland �� Erosion
Prop: Prop: Seismic `fit Streams 7 27P'h, -j
Total: Total: Flood Way x Floodplain 'c
Routing Date: F&WLC- y Landslide k
/ /o3 /�z Shoreline Care Aquifer tie
Forest: Commera _ Rural _k, 7114\--
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 CJZ 08/12/03 58280
Total: $47.00
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UILDING PERMIT APPLICASJN MLA03-00463
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00507 Received Date: 8/12/2003
SITE ADDRESS: 80 BURNS RD
PORT HADLOCK, 98339
OWNER: DAVID W HEID PHONE:
BARBARA L HEID
80 BURNS RD
PORT LUDLOW WA 983659425
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 921194011 Section: 19 Township: 29 N Range: 01 E
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 09/06/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION Underground Propane Tank
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 1997 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
/o3
zo
z Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 CJZ 08/12/03 58280
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#: BLD03-00507 Received Date 8/12/2003
SITE ADDRESS: 80 BURNS RD Issue Date 8/13/2003
PORT HADLOCK, 98339
APPLICANT: DAVID W HEID PHONE:
BARBARA L HEID
80 BURNS RD
PORT LUDLOW WA 983659425
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 921194011 Section: 19 Township: 29N Range: 01 E
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 09/06/2004
OWNER, DAVID W HEID PHONE:
if different: BARBARA L HEID
80 BURNS RD
PORT LUDLOW WA 983659425
PROJECT DESCRIPTION: Underground Propane Tank
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 08/13/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: �4 2 /y>< -z
[ ] FinalApproval:
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.c
JEFFERSON COUNTY COMMUf"JEVELOPMENT,621 SHERIDAN ST,PORT TOWN D 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):
*-�1j'Co /3 1 K15 A W
12 0
O r t L.u41 I ZIP U (s J
9 DIGIT PARCEL ID NUMBER C! lq O I I
Legal Description: ?,,, e I
Subdivision Name ,'" i Block
Lot(s)
Section J 1 Township 2/ North, Range } t^.l WM
APPLICANT D4 I Q 14-rc ) PHONE (3.60J 4/1 7 - '5(.2 .9
MAILING ADDRESS 5'0 fs 4 D /�
Pc `' (_r-�,,t(l/r� > A ZIP 4>.5 L J q
PROPERTY OWNER PHONE 36G t ?"(. 7 /
MAILING ADDRESS
ZIP
CONTRACTOR e IL M t? PHONE
MAILING ADDRESS
ZIP
STATE LICENSE# 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 entry to the applicant's property or struct a shal tie requested and shall occur during regular business hours.
APPLICANTS SIGNATURE DATE / JO / ` Oo
LA } '"0.� ���FOR OFFICE USE ONLY
BASE FEE � I ' 2 RECEIPT# 5 ��
CONSISTENCY REVIEW aJ- CASH/CK#
TOTAL DATE /12 /
*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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