HomeMy WebLinkAboutBLD2003-00570 a
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 #: BLD03-00570 Received Date 9/12/2003
SITE ADDRESS: 7782 BEAVER VALLEY RD Issue Date 9/12/2003
CHIMACUM, 98325
APPLICANT: GROVER E GRADY III PHONE:
PO BOX 296
CHIMACUM WA 983250296
31
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 901242016 Section: 24 Township: 29N Range: 01W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTP198306 Expires 09/26/2004
OWNER, GROVER E GRADY III PHONE:
if different: PO BOX 296
CHIMACUM WA 983250296
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 09/12/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: ?�,p4t.sE TwNv._ olC lG eOrik. L. OK- 1111516
[ ] FinalApproval: OK .Vvv- C1Ma1 i1/i5/0q U"
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 APPLICOION B RDOe 00w p5e70
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00570 Received Date: 9/12/2003
SITE ADDRESS: 7782 BEAVER VALLEY RD
CHIMACUM, 98325
OWNER: GROVER E GRADY III PHONE:
PO BOX 296
CHIMACUM WA 983250296
SUBDIVISION: Block: Lot: 31
PARCEL NUMBER: 901242016 Section: 24 Township: 29 N Range: 01 W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTP198306 Expires 09/26/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP Above Ground Propane Tank
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION
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 CJZ 09/12/03 60018
Total: $47.00
JEFFERSON COUNTY COMMU•DEVELOPMENT,621 SHERIDAN ST,PORT TOWeD 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):
??t &-.94--4 141/-46,-/ 4P.
Cem4fcc , w(/. 3?-6 ZIP
9 DIGIT PARCEL ID NUMBER /0/^ 72" d/.46
Legal Description:
Subdivision Name Block Lot(s)
��(�� Section Township' / Township North, Range ^� WM
APPLICANT GQQ 'Lam,`qq.. L%r�`97 7 PHONE 7 34� 7y7d
MAILING ADDRESS 'ex g/-6 /
C - Mfl Eu792, wn (O 3 ZIP
PROPERTY OWNER SAC PHONE
MAILING ADDRESS
�,-/ /1,, ZIP
CONTRACTOR 7Oa'j7//v "00°/,�E- PHONE
MAILING ADDRESS 'l
/OQ17 �4-P ec. 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- esult of or in consequence of the granting of this permit.
I further agree to provide access an• ',p of entry to Jefferso ounty i's employe ,representatives or agents for the purpose of application review and any required later
inspections. Access and right of en the app_licannt's/pro{ t or st shall be sted an occur during regular business hours. ?
APPLICANTS SIGNATURE II/��i���v - / DATE /0 //Z' / °✓
BASE FEE <1"1 cc FOR OFFICE USE ONLY RECEIPT# &On l A
CONSISTENCY REVIEW CASH/CK# 5S9
TOTAL 0 DATE / / / - /a- .
*Underground Propane Tank applications require additional information to be submitted. 0 V E R I� II► 10.
Please contact our office at 360-379-4450 if the back of this application is blank.
g:\permitcenter\forms\bldg forms\install-revised 10-23-02.doc