HomeMy WebLinkAboutBLD2003-00513 •.
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 #: BLD03-00513 Received Date 8/14/2003
SITE ADDRESS: 141 DOSEWALLIPS RD Issue Date 8/14/2003
BRINNON, 98320
APPLICANT: YVETTE JORDAN PHONE:
141 DOSEWALLIPS RD
BRINNON WA 983209619
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 602353027 Section: 35 Township: 26N Range: 02W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPI983O6 Expires 9/26/2004
OWNER, YVETTE JORDAN PHONE:
if different: 141 DOSEWALLIPS RD
BRINNON WA 983209619
PROJECT DESCRIPTION: PROPANE 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 8/14/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:` dA ) LhoEs OK y/x/i
[ ] FinalApproval: OK 40r C/d 9/9/r93
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_B LD_Perm it_Propane.rpt 10/29/19
• BUILDING PERMIT APPLICIPTION BLD03-00513
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00513 Received Date: 8/14/2003
SITE ADDRESS: 141 DOSEWALLIPS RD
BRINNON, 98320
OWNER: YVETTE JORDAN PHONE:
141 DOSEWALLIPS RD
BRINNON WA 983209619
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 602353027 Section: 35 Township: 26 N Range: 02 W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTP1983O6 Expires 9/26/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPT10/1 PROPANE 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: F&W Landslide
Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 PRB 08/14/03 58317
Total: $47.00
JEFFERSON COUNTY COMM•Y DEVELOPMENT,621 SHERIDAN ST,PORT TOV•ND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* x 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 y NO
SITE ADDRESS(911#/Road Name):
17v is ra
ZIP Y2
9 DIGIT PARCEL ID NUMBER (P - G_..
Legal Description:
Subdivision Name Block Lot(s)
Section — `� Township /LI North, Range Z9'" . WM
y,
APPLICANT PHONE —
MAILING ADDRESS / / CS` t' (A.11/4-C--t:( f
( G1 ,/e ZIP 9 CCU
PROPERTY OWNER PHONE
MAILING ADDRESS
ZIP
CONTRACTOR NMtN1��1� �'° ` 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 ri ht of entry to Jeff on County and is mployees,representatives or agents for the purpose of application review and any required later
inspections. Access and right of entry) pica ' p structur II be r uested and shall occur during regular business hoes.
APPLICANTS SIGNATURE r � DATE / / .`/ 0_°3
OR OFFICE USE ONLY
BASE FEE RECEIPT#
CONSISTENCY VIEW 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.
H:IHOME\PLNCNTR\INFOBLDG\FORMS\I NSTALL.DOC