HomeMy WebLinkAboutBLD2003-00538 •
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 #: BLD03-00538 Received Date 8/28/2003
SITE ADDRESS: 341 VERNER AVE Issue Date 8/28/2003
PORT LUDLOW, 98365
APPLICANT: CLAYTON E HAM PHONE: 360-437-2115
341 VERNER AVE
PORT LUDLOW WA 983659422
SUBDIVISION: OLYMPUS BEACH Block: Lot:
PARCEL NUMBER: 978900093 Section: 4 Township: 28N Range: 01E
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 09/06/2004
OWNER, CLAYTON E HAM PHONE: 360-437-2115
if different: 341 VERNER AVE
PORT LUDLOW WA 983659422
PROJECT DESCRIPTION: ABOVE GROUND 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 08/28/2004.
REQUIRED INSPECTIONS:
ine/Appliance: Old 03/43
] �{IC-"" pproval: Ok -Per- e'/0 y/1.5/3 j I
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 APPLIION
BLD03-00538 Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00538 Received Date: 8/28/2003
SITE ADDRESS: 341 VERNER AVE
PORT LUDLOW, 98365
OWNER: CLAYTON E HAM PHONE: 360-437-2115
341 VERNER AVE
PORT LUDLOW WA 983659422
SUBDIVISION: OLYMPUS BEACH Block: Lot:
PARCEL NUMBER: 978900093 Section: 4 Township: 28 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 DESCRIPTIOP ABOVE GROUND PROPANE TANK
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
Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 ZAN 08/28/03 58458
Total: $47.00
JEFFERSON COUNTY COMRY DEVELOPMENT,621 SHERIDAN ST,PORT TCEND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* l i 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):
1// l/4rc'r1/ /
ZIP C'S -" 1/ 2
9 DIGIT PARCEL ID NUMBER 78 96)22z29..3
Legal Description:
Subdivision Name Block Lot(s)
/Section Township North, Range WM
APPLICANT �L, 7// /V/ t, /7//7 A.1 PHONE "/ ,3 7"
MAILING ADDRESS 3'/ Ir/L -,i e')" /Lij/e
f41717 ZIP 9836 97Y
PROPERTY OWNER ���{/)'1 PHONE
MAILING ADDRESS
ZIP
CONTRACTOR 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 ntry to the applicant's property or structure shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE r d / '�✓t� DATE .C7 / Ze6 / 0_S
Oa FOR OFFICE USE ONLY
BASE FEE "i • RECEIPT#
CONSISTENCY REVIEW CASH/CK#
TOTAL'.r 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. IMME
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