HomeMy WebLinkAboutBLD2003-00571 • BUILDING PERMIT APPLIiION B RDOe 00w p5e71
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00571 Received Date: 9/15/2003
SITE ADDRESS: 7570 OAK BAY RD
PORT LUDLOW, 98365
OWNER: WILLIAM D BARKER PHONE:
FRANCES BARKER
7570 OAK BAY RD
PORT LUDLOW WA 983659411
SUBDIVISION: EDSALL SHORT PLAT Block: Lot: 3
PARCEL NUMBER: 978900126 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 9/6/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr 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 09/15/03 60070
Total: $47.00
JEFFERSON COUNTY COMElif Y DEVELOPMENT,621 SHERIDAN ST,PORT TO•END 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 (T 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):
,. . -2 0 n (VX E-17,41)7/El-
?o-rTfdpoc )p' t e,e) ZIP 7 3 ,
9 DIGIT PARCEL ID NUMBER 7 v ' o igc,,
Legal Description:Subdivision Name t C-P-A S h,,% 5'7- =7)_/7 7---
Block Lot(s)
Section Township North, Range WM
APPLICANT �/�,,��� �i� P�'�� PHONE 7.60 'y7(3?- Sz�'
MAILING ADDRESS /i?e / (/a AV 1
PT'�`TL4d ekG1I.IJ 4_ ZIP �� /Y ^�
PROPERTY OWNER r/F '�� PHON�66 — 3< f10S`L3
MAILING ADDRESS ,_-5---)4 M
ZIP
CONTRACTOR )1,/--Q._7(
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 Co ty and it's empl ees,representatives or agents for the purpose of application review and any required later
inspections. Access and right of entry to p' is propert or r re shall requested and shall occur during regular business hours.
APPLICANTS SIGNATURE 4 t% DATE ! / S /C%
FOR OFFICE USE ONLY
BASE FEE RECEIPT#
CONSISTENCY REVIEW CASH/CK#
TOTAL DATE / /
*Underground Propane Tank applications require additional information to be submitted. 0 V E R (► 0.
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
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 #: BLD03-00571 Received Date 9/15/2003
SITE ADDRESS: 7570 OAK BAY RD Issue Date 9/15/2003
PORT LUDLOW, 98365
APPLICANT: WILLIAM D BARKER PHONE:
FRANCES BARKER
7570 OAK BAY RD
PORT LUDLOW WA 983659411 3
SUBDIVISION: EDSALL SHORT PLAT Block: Lot:
PARCEL NUMBER: 978900126 Section: 4 Township: 28N Range: 01 E
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 9/6/2004
OWNER, WILLIAM D BARKER PHONE:
if different: FRANCES BARKER
7570 OAK BAY RD
PORT LUDLOW WA 983659411
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 9/15/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: p,vk rNSiAtd.A7'm,J OK ///4/051 ►
[ ] FinalApproval: -CT -Oa / 11/4/041
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