HomeMy WebLinkAboutBLD2003-00581 BUILDING PERMIT •
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD03-00581 Received Date 09/18/2003
SITE ADDRESS: 6062 SR20# 3- Issue Date 09/18/2003
PORT TOWNSEND, 98368
APPLICANT: VIRGINIA BROWN PHONE:
6062 HWY 20#68
PORT TOWNSEND WA 98368
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 001333004 Section: 33 Township: 30 N Range: 01 W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License: MOUNTP1983O6 Expires: 09/26/2004
LOAN LENDER/
BOND HOLDER:
PROJECT DESCRIPTION: Above Ground Propane Tank
REQUIRED INSPECTIONS:
[ ] SETBACKS:
[ ] UFFER:
[ ] Footing:
[ ] Foundation:
[ ] Underground Plumbing:
[ ] Underground Insulation:
[ ] Shear Wall :
[ ] Framing:
1 1 Plumbing:
[ ] Propane Tank/ Lines:
[ ] Insulation:
1 1 Sheetrock:
[ ] Septic Sytem Final Approval:
1 Zoning Final Approval:
[°] Final/Occupancy Approval:
HEALTH DEPARTMENT APPROVAL REQUIRED Pf110 T FINAL INSPECTION
THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE P OPERLY RENEWED
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
•BUILDING PERMIT APPLIC ION B Review
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD03-00581 Received Date: 9/18/2003
SITE ADDRESS: 6062 SR20t�
PORT TOWNSEND, 98368
OWNER: VIRGINIA BROWN PHONE:
6062 HWY 20#68
PORT TOWNSEND WA 98368
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 001333004 Section: 33 Township: 30 N Range: 01 W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPI983O6 Expires 09/26/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION Above Ground Propane Tank
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 CJZ 09/18/03 60027
Total: $47.00
JEFFERSON COUNTY COMMU•DEVELOPMENT,621 SHERIDAN ST,PORT TOW,D WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* x 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):
D- I.0 (' /1�fiV-c o -
to �0` l`?'L�Gibt�� LUc r ZIP o f 3Co
9 DIGIT PARCEL ID NUMBER ' "‘rv-i3+:to 4O 3-� I Cpn� g '7 a 6OloE
Legal Description: l/ {/
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT [i'�� !L �-rf 2C/ r l
� PHONE��p L7 is S � l S! '
MAILING ADDRESS 121 �0 [�/ Z-� 6,C-^
�
�/ ` �'v vZi`7�-�� �� r ZIP % (f �w/O
PROPERTY OWNER Q!! -E�PHONE Z�
MAILING ADDRESS (t7 (D Ac% 9 p��4 It1
/ q
W `�/et ZIP el'S 3b
CONTRACTOR 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 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 property or structure shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE DATE / /
-47
„ FOR OFFICE USE ONLY W��
BASE FEE RECEIPT#
CONSISTENCY REVIEW 0 CASH/CK# /01 3
TOTAL 11 '. DATE I / 17 / POo 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.
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