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HomeMy WebLinkAboutBLD2003-00579 •BUILDING PERMIT APPLICSON BL Review T Ty y575 pe: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD03-00579 Received Date: 9/17/2003 SITE ADDRESS: 190 MASONIC HALL RD PORT HADLOCK, 98339 OWNER: RONALD L MELHEIM PHONE: CAROL WISE 3049 W SIMS WAY PORT TOWNSEND WA 983682255 SUBDIVISION: Block: Lot: T 5+ PARCEL NUMBER: 901024007 Section: 2 Township: 29 N Range: 01 W CONTRACTOR: RON MELHEIM CONSTRUCTION PHONE: 360-385-9478 PO BOX 988 PORT TOWNSEND WA 98368 Contractor's License RONMEC*994QL Expires 11/13/2003 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOJ' Above Ground Oil tank and Heater Stove Commercial Building 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: 05tIddteV Propane Tanks/Stoves $47.00 CJZ 09/17/03 60029 Total: $47.00 SEP 1 9 2003 Jefferson County Planning & Building Department r",/,/ g Cc JEFFERSON COUNTY COMMUIEVELOPMENT,621 SHERIDAN ST,PORT TOWD 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) CY i t 6 T A V ) .t5� AO izi\(� Is this appliance(htg stove, hot water tank,furnace,etc.)to be installed in a Manufactured/Mobile Home? YES X NO SITE ADDRESS(911#/Road Name): Iqo M►9�Ot (C.-Township c HALL QAO `PoOT Af teat. ZIP ` D3�J'1 9 DIGIT PARCEL ID NUMBER e0 ( CCI'),,f go( 09A 0O9 Lega Description:a t S q -30 I Subdivision Name `l Block RLot(s) Section Township 0 North, Range ) 0 WM APPLICANT C(ZOL A, v3(c-{ PHONE 37 -ill 0 k9C r' . MAILING ADDRESS gi) q-ct St ris W Ati I t- I © tAKIGLT1D (_ VO4-- ZIP `'1$JInR PROPERTY OWNERYY1,t. PHONE MAILING ADDRESS ZIP CONTRACTOR (2013 Metiv.IVht 1 PHONE MAILING ADDRESS Pb6 CI ZIP STATE LICENSE# gDmEc g"1 iti EXP.DATE FEDERAL I.D.# By signing the application form,the applicant/owner attests that the information provided herein is true and correct to the best of their knowledge. Any material falsehood or any omission of a material fact made by the applicant/owner with respect to this application packet may result in this permit being null and void. I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and rigs a -ntry Jefferson ounty a`' em.-•ees,representatives or agents for the purpose of application review and any required later inspections. Access and right of entry . he pplica is. o '., . .-II be requested and shall occur during regular business hours. APPLICANTS SIGNATURE 1 , /V. DATE / 11 /©�j 9, �„ FOR OFFICE USE ONLY BASE FEE RECEIPT# 606 a9 CONSISTENCY REVIEW —0 CASH/CK# 3o81- TOTAL �— DATE 9/ Pi/ 3 *Underground Propane Tank applications require additional information to be submitted. 0 V E R Please contact our office at 360-379-4450 if the back of this application is blank., , � g:\permitcenter\forms\bldg forms\install-revised 10-23-02.doc r i .. • JEFFERSON COUNTY DCD _' rt ,t:, ,$. ,. ', ;I:k, i. ' , ' 0 ` T m r rh _ 1--1- Ei_� 1 � i I i , I 4 ` I i ' i it { I 1 , 1 CO i0 , , i 1 T la i 1 1 i1 I E , 1 P '-' .!.. I i -r i i 1 i , i ! _ , — ! n 1 rs cle i p r r e 0 r_. 1z` ! r o P • • PROPANE/PELLET/WOOD STOVE & TANK INSTALLATION PERMIT Jefferson County Department of Community Development 621 Sheridan Stre t! 4I i T w -id, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD03-00579 Received Date'' 9/17/2003 SITE ADDRESS: 190 MASONIC HALL RD Issue Date 9/19/2003 PORT HADLOCK, 98339 APPLICANT: RONALD L MELHEIM PHONE: CAROL WISE 3049 W SIMS WAY PORT TOWNSEND WA 983682255 T 5+ SUBDIVISION: Block: Lot: PARCEL NUMBER: 901024007 Section: 2 Township: 29N Range: 01W CONTRACTOR: RON MELHEIM CONSTRUCTION PHONE: 360-385-9478 PO BOX 988 PORT TOWNSEND WA 98368 Contractor's License RONMEC*994QL Expires 11/13/2003 OWNER, RONALD L MELHEIM PHONE: if different: CAROL WISE 3049 W SIMS WAY PORT TOWNSEND WA 983682255 PROJECT DESCRIPTION: Above Ground Oil tank and Heater Stove Commercial Building 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 09/19/2004. REQUIRED INSPECTIONS: [ ] Tank/Line/Appliance: (C`-. —y$- p 4( [ ] FinalApproval: C9 W E-7-6 to - 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£ ON • • 444 % JEFFERSON COUNTY . DEPARTMENT OF COMMUNITY DEVELOPMENT �'�' 621 Sheridan Street • Port Townsend • Washington 98368 �t 360/379-4450 • 800/831-2678 • 360/379-4451 Fax BUILDING PERMIT SUPPLEMENTAL CONTACT INFORMATION eeejoiloevb49 �edadCOffLed a4 : Project Description: IM9L OIL 44EAT RgrGl3fr. — 9 Digit Parcel Identification Number(from your tax statement): Site Address 911#: Igo Road Name: VV\ OK),IC Mk a Zip Code: 934/ Legal Description Subdivision Name: Block: Lot(s): Parcel Size (acres or square footage): Property Owner: �L if Phone: am_ 3 11tI- Mailing Address: 3 -9 Su vvi lAmul �.� T o sL O, Wt.) . q$3 S Applicant/Occupant: S Phone: (if different from owner) Mailing Address: Authorized Rep: ciivvut Phone: Mailing Address: General Contractor: Or Manufactured Home Installer: MOM Phone: Mailing Address: Contractor's State License Number: Expiration Date: Architect:/Engineer: Phone: Mailing Address: ' G:\PERMIT CENTER\FORMS\BLDG SUPP INFO