HomeMy WebLinkAboutBLD2003-00601 BUILDING PERMIT APPLI TION BLDOe 00601
Reviw Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00601 Received Date: 9/25/2003
SITE ADDRESS: 4392 DISCOVERY RD
PORT TOWNSEND, 98368
OWNER: E LORRAINE TRAUTMAN PHONE:
91 SIMCOE RD
PORT TOWNSEND WA 983689657
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 001324017 Section: 32 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 DESCRIPTIOP TWO - 120 GAL PROPANE TANKS, GAS HEAT STOVE, GAS PIPE
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 ZAN 09/24/03 60086
Total: $47.00
•
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 #: BLD03-00601 Received Date 9/25/2003
SITE ADDRESS: 4392 DISCOVERY RD Issue Date
PORT TOWNSEND, 98368 9/25/2003
APPLICANT: E LORRAINE TRAUTMAN
91 SIMCOE RD PHONE:
PORT TOWNSEND WA 983689657
SUBDIVISION: Block:
Lot:
PARCEL NUMBER: 001324017 Section: 32 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, E LORRAINE TRAUTMAN
if different: 91 SIMCOE RD PHONE:
PORT TOWNSEND WA 983689657
PROJECT DESCRIPTION: TWO - 120 GAL PROPANE TANKS, GAS HEAT STOVE, GAS PIPE
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 09/25/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: % )& iiJf `,N t v
Fick-r o 00/4761,
[ ] FinalApproval: d K --�pr (�' vv2.( toitjOt/fr
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 10/29/19f
JEFFERSON COUNTY COMITY DEVELOPMENT,621 SHERIDAN ST,PORT T•SEND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
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6-6-9Underground PROPANE TANK Above and/i 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):
Y3 9)- A - AJ
PT. O?u1,4-d-r.JL, / 1 )9 ZIP
._ (d73 �'J-7
9 DIGIT PARCEL ID NUMBER e0/ "2V 0 / 7
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT h ay' — <r-e-- PHONE
MAILING ADDRESS 6
,,// • ZIP
f PROPERTY OWNER oid l<e PHONE
MAILING ADDRESS
ZIP
CONTRACTOR �^-'-� PHONE ' 9
MAILING ADDRESS /0 te l 1Kv, fl 7
f/ 7v.4 (,)c-- ZIP 9O ..,)J
STATE LICENSE# Ju h,I27L-P 0 7 7 f r EXP. DATE 1f/ d it
FEDERAL I.D.# f` / /0 7! cE1 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.
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 the applicant's property or structure shall be requested and shall occur during regular business hours.
APPLICANT'S SIGNATURE 17Irk-v1r DATE -/ / 21 1 v 3
0 1-•� OZ FOR OFFICE USE ONLY
BASE FEE ''1 L RECEIPT# 100 UO L
CONSISTENCY REVIEW ----PC______ CASH/CK# 9 _ es
S
TOTAL 41 •o° DATE / /2-Y 0 5
*Underground Propane Tank applications require additional information to be submitted. OVER
Please contact our office at 360-379-4450 if the back of this application is blank. Mill+
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