HomeMy WebLinkAboutBLD2003-00546 0
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#: BLD03-00546 Received Date 8/29/2003
SITE ADDRESS: 31 FREEMAN LN Issue Date 9/2/2003
PORT TOWNSEND, 98368
APPLICANT: LAWRENCE K ROBBINS PHONE:
SARAH ROBBINS
2460 ASHWOOD DR
LONGVIEW WA 98632 60
SUBDIVISION: DISCOVERY BAY VILLAGE Block: Lot:
PARCEL NUMBER: 947400060 Section: 13 Township: 29N 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, LAWRENCE K ROBBINS PHONE:
if different: SARAH ROBBINS
2460 ASHWOOD DR
LONGVIEW WA 98632
PROJECT DESCRIPTION: NO MLA REQ'D -ABOVE GROUND 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 9/2/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance C. 0-Nag
[ ] FinalApproval: /,c//(,e /Q J(-a,
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
ELDING PERMIT APPLICATI• BLD03-00546
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00546 Received Date: 8/29/2003
SITE ADDRESS: 31 FREEMAN LN
PORT TOWNSEND, 98368
OWNER: LAWRENCE K ROBBINS PHONE:
SARAH ROBBINS
2460 ASHWOOD DR
LONGVIEW WA 98632
SUBDIVISION: DISCOVERY BAY VILLAGE Block: Lot: 60
PARCEL NUMBER: 947400060 Section: 13 Township: 29 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 -ABOVE GROUND 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: 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
Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 MJA 08/29/03 58236
Total: $47.00
JEFFERSON COUNTY COMMUNOOLOPMENT,621 SHERIDAN ST,PORT TOWN 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATIO
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
J 0 4-Ld=`
Underground PROPANE TANK* Above Ground PROPANE TANK / • HEATTOVE _HOT WATER TANK
WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE
t
/' OTHER(Please Specify) - p L .
./P-
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):
3/ 4,,
I cZ ctoe._ ZIP Y _I(.a2
9 DIGIT PARCEL ID NUMBER `l f 1-4 0 U-0 CO 0
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT _ n 4w`,CJ .S 1 1 r'ti--l-) PHONE
MAILING ADDRESS 2 / f�-ema,...1_ 1-----t) ,
2 A ZIP i'd'. 67d'
i
PROPERTY OWNER 9 .- -1 t., ..7` PHONE
MAILING ADDRESS S{
ZIP CONTRACTOR l.Aw-rr--4 A p,„_,.. PHONE 3OP J 7(C 7
MAILING ADDRESS l D�C� /I���.tr,Qr_ !/` p
f'`/ �� ZIP ! O 13 j
STATE LICENSE# -. '�+-- j`-P a'7 4Q e EXP.DATE 7(70 Li
FEDERAL I.D.# 7/�— /D 7 q Fs?
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
sp property or structure shall be requested and shall occur during regular business hours.
APPLICANT'S SIGNATURE (' 7 /) -d DATE !Kgu! � / °3
FOR OFFICE USE ONLY
BASE FEE RECEIPT#
CONSISTENCY REVIEW CASH/CK#
TOTAL DATE _/ /
*Underground Propane Tank applications require additional information to be submitted. OVER
Please contact our office at 360-379-4450if the back of this application is blank. IIMIE
HAHO 1PLMNTRUNFOBLDG\FOM SN TA_
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ciI AUG 2 9 2003
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