HomeMy WebLinkAboutBLD2003-00582 • BUILDING PERMIT APPLI•TION BLD03-00582
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00582 Received Date: 9/18/2003
SITE ADDRESS: 1070 EGG & I RD
CHIMACUM, 98325
OWNER: MARJORIE A BOYD PHONE:
1064 EGG AND I RD
CHIMACUM WA 983259722
SUBDIVISION: Block: Lot: 4
PARCEL NUMBER: 801022003 Section: 2 Township: 28 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 DESCRIPTIOl ABOVE GROUND PROPANE TANK, HEAT STOVE, COOKING STOVE,
ON-DEMAND HOT WATER HEATER
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
/O 03 Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 ZAN 09/18/03 58493
Total: $47.00
JEFFERSON COUNTY COMM TY 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 L.-COOKING STOVE
L MThER(Please Specify) Qr-i-Ap :4 0, 'l t 01 (2 oto fl tQ,,\
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):
O 6'6-6 ' .L
C.t-A l rJ p. i L(`� f (,(A ZIP a K. ZS
c
9 DIGIT PARCEL ID NUMBER V O I G Zi o O ,
Legal Description: rz..l t. 3
Subdivision Name4-L./Ilk eW I Lk c C-k 2- 1 C'- '7 i'.'SIKi Block Lot(s)
Section '7-- Township 2 K) North, Range (Zj L,,...) WM
APPLICANT m l r�( Y < PHONE ( CO0 1-PDz-(10 i
MAILING ADDRESS I C L Z RA
C�-�\( N\ �(f 0\A f CJ .:(\ c( c53Z:j ZIP
PROPERTY OWNER „"CC PHONE
MAILING ADDRESS
ZIP
CONTRACTOR ArV i- Gtlk\-N, ijYaN2 . PHONE
MAILING ADDRESS 'i-‘6 ( fir,!('(.Z.
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. I
APPLICANTS SIGNATURE ,_7 4,t� ("i DATE / / CO / LIi
03FOR OFFICE USE ONLY
BASE FEE / �y�• RECEIPT# /, R ! J 3
CONSISTENCY REVIEW �"V CASH/CK# �w�
TOTAL 1Ir W DATE ( LE.d23
*Underground Propane Tank applications require additional information to be submitted. 0 V E R I►
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 #: BLD03-00582 Received Date 9/18/2003
SITE ADDRESS: 1070 EGG & I RD Issue Date 9/18/2003
CHIMACUM, 98325
APPLICANT: MARJORIE A BOYD PHONE:
1070 EGG AND I RD
CHIMACUM WA 983259722
4
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 801022003 Section: 2 Township: 28N Range: 01W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPI983O6 Expires 09/26/2004
OWNER, MARJORIE A BOYD PHONE:
if different: 1070 EGG AND I RD
CHIMACUM WA 983259722
PROJECT DESCRIPTION: ABOVE GROUND PROPANE TANK, HEAT STOVE, COOKING
STOVE, ON-DEMAND HOT WATER 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 09/18/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: G.-, rift 9I-,21-ty
[ ] FinalApproval. ra4A3-477'
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 10/29/19C.