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HomeMy WebLinkAboutBLD2003-00593 110 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 #: BLD03-00593 Received Date 9/23/2003 SITE ADDRESS: 170 MAPLE Issue Date 9/23/2003 PORT HADLOCK, 98339 APPLICANT: ROGER G DUMONT PHONE: PO BOX 123 CHIMACUM WA 983250123 11 SUBDIVISION: PHILLIPS TO IRONDALE Block: 3 Lot: PARCEL NUMBER: 986400306 Section: 2 Township: 29N Range: 01W CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CENEXHS022NQ Expires 09/06/2004 OWNER, ROGER G DUMONT PHONE: if different: PO BOX 123 CHIMACUM WA 983250123 PROJECT DESCRIPTION: Above Ground Propane Tank& Heat Stove 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: i.�1-,��i< r, �� ,; .rr•�= ?�t � [ ] FinalApproval: ;:'✓t« Q'�© 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. °BUILDING PERMIT APPLIC/ON BL v Reviewiew T Ty593 ype: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD03-00593 Received Date: 9/23/2003 SITE ADDRESS: 170 MAPLE PORT HADLOCK, 98339 OWNER: ROGER G DUMONT PHONE: PO BOX 123 CHIMACUM WA 983250123 SUBDIVISION: PHILLIPS TO IRONDALE Block: 3 Lot: 11 PARCEL NUMBER: 986400306 Section: 2 Township: 29 N Range: 01 W CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CENEXHS022NQ Expires 09/06/2004 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION Above Ground Propane Tank & Heat Stove 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: 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: Approved/Date Propane Tanks/Stoves $47.00 CJZ 09/23/03 60047 Total: $47.00 JEFFERSON COUNTY COMMUNI•VELOPMENT,621 SHERIDAN ST,PORT TOWN*WA 98368 PH: (360)379-4450 INSTALLATION PERMIT APPLICATION MARK ALL ITEMS BELOW THAT PERTAIN TO THI ALLATION Underground PROPANE TANK* Above Ground PROPANE TANK EAT STOVE HOT WATER TANK WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE OTHER(Please Specify) Is this appliance (htg stove, hot water tank,furnace, etc.)to be installed in a Manufactured/Mobile Home? YES NO SITE ADDRESS(911#/Road Name): / ? 0 5 244 t 2-e— /7‘Gr-i(G (At c /r ZIP 2 9- 3 3 / 9 DIGIT PARCEL ID NUMBER 7$- Y1 D .7c,G Legal Description: Subdivision Name Block Lot(s) Section Township North, Range WM APPLICANT -0.. /0/4.444-0 T— PHONE 3 7 7 7/ r/ MAILING ADDRESS _ / z 3 ZIP PROPERTY OWNER 547 ys,- ---.C... _ PHONE MAILING ADDRESS ZIP CONTRACTOR G .e- v., 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 rig : 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 . - pplicant's pr.•-,y or structure shall be requested and shall occur during regular business hours. p APPLICANTS SIGNATURE / A-Q DATE/23 / FOR OFFICE USE ONLY BASE FEE 9i. RECEIPT# (G(fC 9 1 CONSISTENCY REVIEW CASH/CK# i as TOTAL DATE c"J /: 3/ 0 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