HomeMy WebLinkAboutBLD2003-00605 • •
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 #: BLD03-00605 Received Date 9/26/2003
SITE ADDRESS: 85 HEINZINGER RD Issue Date 9/26/2003
NORDLAND, 98358
APPLICANT: DAVID R HEINZINGER PHONE:
GLADYS E HEINZINGER
PO BOX 152
NORDLAND WA 983580152
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 021294036 Section: 29 Township: 30N Range: 01 E
CONTRACTOR:
OWNER, DAVID R HEINZINGER PHONE:
if different: GLADYS E HEINZINGER
PO BOX 152
NORDLAND WA 983580152
PROJECT DESCRIPTION: Above Ground Propane Tank& Fireplace Insert& Piping
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 09/26/2004.
REQUIRED INSPECTIONS:
[ ] Tan.' "ppliance• a( ff 4SJ'313V
[ ] FinalApproval: �K .� �D i%,13 ,#
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.
UILDING PERMIT APPLICA ON BLD03-00605
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD03-00605 Received Date: 9/26/2003
SITE ADDRESS: 85 HEINZINGER RD
NORDLAND, 98358
OWNER: DAVID R HEINZINGER PHONE:
GLADYS E HEINZINGER
PO BOX 152
NORDLAND WA 983580152
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 021294036 Section: 29 Township: 30 N Range: 01 E
CONTRACTOR: PHONE:
PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP Above Ground Propane Tank & Fireplace Insert& Piping
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
Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 CJZ 09/26/03 60202
Total: $47.00
JEFFERSON COUNTY COMMUIJEVELOPMENT,621 SHERIDAN ST.PORT TOWID WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* Above Ground PROPANE TANK HEAT STOVE HOT WATER TANK
WOODSTOVEFIREPLACE INSERT PELLET STOVE COOKING STOVE
/ r r
4 OTHER(Please Specify) ', /P 5
Is this appliance(htg stove, hot water tank,furnace,etc.)to be installed in a Manufactured/Mobile Home?
YES v NO
SITE ADDRESS(911#/Road Name): ^o
S (1 )e ✓� a .rrf g e(r 1 ZpM •
A2c2rd i'q,i d w 4 . // ZIP S 3 sCC$
9 DIGIT PARCEL ID NUMBER a off-) o�(C3 '- ° 3 b
Legal Description:
Subdivision Name Block Lot(s)
Section
Township North, Range WM
APPLICANT 41 O Nn/ Qi /n Pro P PHONE .3SS-- - C S S.3
MAILING ADDRESS a 7 Gh/n-)4f c ti m /?d
t�Or -t HQ )oLk , w �4 . ZIP �5339
r
PROPERTY OWNER U a V 1 -P/ e e J n T J,'J S e r PHONE ?SS - 90 y
MAILING ADDRESS $6 ))74') v Lirn s &r 20
//or ®/ 19 no/ t-,/.4 . ZIP 5 S 3 SFS
CONTRACTOR Mountain Propane PHONE ,3iSS - IfS isg3
MAILING ADDRESS 265 CNlmacum Rd.
Pa#Radecki WA 98339
ZIP
STATE LICENSE# /Y) O Li),± pi//g5g 30.6 EXP.DATE 9 `026 ` o
FEDERAL I.D.# u) _ aoss6 6--S
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 th pplicant's property or structure shall be requested and shall occur during regular business hours.
y j -a
APPLICANTS SIGNATURE DATE 7
FOR OFFICE USE ONLY / ^ _
BASE FEE —' RECEIPT# ((()[)p1Q
CONSISTENCY REVIEW CASH/CK# 53 /y
TOTAL 1 DATE t /Q-ea i O3
*Underground Propane Tank applications require additional information to be submitted.-. _______ V E R 11 II► (►
Please contact our office at 360-379-4450 if the back of this applicalioq E
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