HomeMy WebLinkAboutBLD2003-00592 • S
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 #: BLD03-00592 Received Date 9/23/2003
SITE ADDRESS: 1680 HASTINGS AVE W Issue Date 9/23/2003
PORT TOWNSEND, 98368
APPLICANT: SYLVIA B SASS PHONE:
6101 45TH STREET CT W
TACOMA WA 984666318
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 001043004 Section: 4 Township: 30N Range: 01W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2004
OWNER, SYLVIA B SASS PHONE:
if different: 6101 45TH STREET CT W
TACOMA WA 984666318
PROJECT DESCRIPTION: Above Ground Propane Tank
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 09/23/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[ ] FinalApproval: f.9�/� c_/J- $—p'3
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�
UILDI BLD03-00592
NG PERMIT APPLICN Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00592 Received Date: 9/23/2003
SITE ADDRESS: 1680 HASTINGS AVE W
PORT TOWNSEND, 98368
OWNER: SYLVIA B SASS PHONE:
6101 45TH STREET CT W
TACOMA WA 984666318
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 001043004 Section: 4 Township: 30 N Range: 01 W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2004
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 09/23/03 60038
Total: $47.00
JEFFERSON COUNTY COMMUNIOEVELOPMENT,621 SHERIDAN ST.PORT TOWN WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION ��� O ('�1 �!'A
f" r� •
Underground PROPANE TANK* 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 i tUr lt,,MVk*}il oll
i L- `rY '+_ NO
SITE ADDRESS(911#/Road Name):
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F 1---. 1.--0 0 n cS D� 0) / ZIP
00I vy3 00V
9 DIGIT PARCEL ID NUMBER >T, C, - ,2"7'/T
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT 3 14-- SK,A_. it i 1 3 Li` Y
MAILING ADDRESS "-i
ZIP
PROPERTY OWNER r D SA-d _
Q t/c. _- PHONE
MAILING ADDRESS —Q
ZIP
CONTRACTOR �j e 1t 2' +,-L PHONE
MAILING ADDRESS /0 7n ' n/27 /J r
P l ,�//
(� - s c.,/i I.), ZIP i eli y
STATE LICENSE# :�Ll/7,r h1 p 0 7 7 0 P EXP.DATE /f/®c
/ �
FEDERAL I.D.# '7/ - l 0?l f.S 7
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.
s 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
1 required later inspections. Access and rig t of entry the applicant's property or structure shall be requested and shall occur during regular business hours.
�
APPLICANT'S SIGNATURE ✓`^�� — DATE 5 / ([I/ / eJ
17 —FOR OFFICE USE ONLY /
BASE FEE �� RECEIPT# (aOC E
CONSISTENCY REVIEW CASH/CK# 1320
TOTAL DATE " Ja?2 / 0�3
*Underground Propane Tank applications require additional information to be submitted. 0 V E R I►
r Please contact our office at 360-379-4450 if the back of this application is blank.
g1permitcenter\forms\bldg forms\install-revised 10-23-02.doc