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HomeMy WebLinkAboutBLD2003-00576 • 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#: BLD03-00576 Received Date 9/17/2003 SITE ADDRESS: 175A CHIMACUM RD Issue Date 9/17/2003 PORT HADLOCK,98339 APPLICANT: CAROL L FLETCHER PHONE: PO BOX 640 PORT HADLOCK WA 983390640 T 70 SUBDIVISION: Block: Lot: PARCEL NUMBER: 901024046 Section: 2 Township: 29N Range: 01W CONTRACTOR: ALWAYS COOLING OR HEATING PHONE: (360)779-4377 PO BOX 1601 POULSBO WA 98370 Contractor's License ALWAYHC147NH Expires 2/19/2004 OWNER, CAROL L FLETCHER PHONE: if different: PO BOX 640 PORT HADLOCK WA 983390640 PROJECT DESCRIPTION: INSTALL PROPANE HEATER 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 9/17/2004. REQUIRED INSPECTIONS: [ ] Tank/6e Appliance:{ [ ] FinalApproval: 9 '30,03 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 BLD03-0057E Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD03-00576 Received Date: 9/17/2003 SITE ADDRESS: 175A CHIMACUM RD PORT HADLOCK, 98339 OWNER: CAROL L FLETCHER PHONE: PO BOX 640 PORT HADLOCK WA 983390640 SUBDIVISION: Block: Lot: T 70 PARCEL NUMBER: 901024046 Section: 2 Township: 29 N Range: 01 W CONTRACTOR: ALWAYS COOLING OR HEATING PHONE: (360)779-4377 PO BOX 1601 POULSBO WA 98370 Contractor's License ALWAYHC147NH Expires 2/19/2004 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI INSTALL PROPANE HEATER 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: 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: gin � F&W Landslide f Shoreline Aquifer Forest: Commercial Rural Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $47.00 PRB 09/17/03 60076 Total: $47.00 JEFFERSON COUNTY COMMSY DEVELOPMENT,621 SHERIDAN ST,PORT TOND WA 98368 PH: (360)379-4450 INSTALLATION PERMIT APPLICATION MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION / h(5i'iAJ Underground PROPANE TANK* v Above Ground PROPANE TANK HEAT STOVE HOT WATER TANK WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE / �/ OTHER(Please Specify) PROP/} V E R E ZNor UN l 1 (tE4 Tgre M5T; /it) CORN&R o f C ict NC, Is this appliance(htg stove, hot water tank,furnace, etc.) to be installed in a Manufactured/Mobile Home? YES s/NO SITE ADDRESS(911#/Road Name): ' 7 A OH elute am fid (20RI- f--i a6[(r c,f< (4/A ZIP /O 1 37 9 DIGIT PARCEL ID NUMBER f o/ 0 ! 0 Legal Description: Subdivision Name Block Lot(s) / Section Township ,/Township North, Range WM APPLICANT �` W Q yS `/�Od�I✓�/ Dr (1 �i el? PHONE 60- 6 7 7 '(3 7 2 MAILING ADDRESS P 0 V©k , /C,O! f' / I Pbc.,tL C(, / w/k ZIP ` 63 7O PROPERTY OWNER i/i1ZL WO0 0 I.E.y / C Ifietx. fa-T Ctst R PHONE MAILING ADDRESS P 0 9O.r t(O POki WADIZci wg ZIP ` b 3 3 7 CONTRACTOR A`(,c/e,YS Coot! (,r H at/4/ PHONE 51-11l C MAILING ADDRESS lj/6cii t' �1 ZIP q p/ STATE LICENSE# 4 L(.,t it )'f c (L/7 At/-( EXP.DATE t7/Q/6 FEDERAL I.D.# g(q 3 36 ( 2-( 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 apply nt's property or structure shall be requested and shall occur during regular business hours. APPLICANTS SIGNATURE R./J DATE c: / / 7 / 0 3 BASE FEE '00 FOR OFFICE USE ONLY RECEIPT# t t� �^` CONSISTENCY REVIEW 6 r` CASH/CK# I� TOTAL "�{`1 0t1 DATE a / 11 /03 *Underground Propane Tank applications require additional information to be submitted. 0 V E R (► 110. 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 rIVitE I'' 11 C L� UUU \ 7 Eirn) nrle 1 7 Ill ILY-11 JEFFERSON COUNTY DEPT. OF COMMUNITY DEVELOPMENT